The changing role of Maasai men in maternal health

James Senjura works closely with the Maasai pastoralist community of Laikipia, Kenya, to improve maternal and child health. He is a Project Officer for Mothers’ Union, Anglican Overseas Aid’s partner in The Road Less Travelled project, and also a father and positive role model for other men in his community. The project works with the community to identify key development challenges, and helps to develop locally-appropriate solutions to deliver basic health care and education where access to formal services is limited. James answers some questions about traditions and gender norms relating to maternal and child health within his culture.

In the Maasai community of Laikipia, how would you describe the traditional role of men in maternal and child health?

Traditionally, men’s role in maternal and child care has been passive. Maternal and child health care was in the hands of traditional birth attendants and old women.

Mostly men provide financial support and organise for transportation, and sometimes in consultation with the traditional birth attendant they decide for further action in case of complications or disease occurring. The father would advise on the estimated date of delivery, so that the woman would be prepared.

Image: Matthew Willman / Anglican Overseas Aid

Traditionally, the role of Maasai men in maternal health and child care has been a passive one. Image: Matthew Willman / Anglican Overseas Aid

It was also the role of man to source food (slaughter animals, draw blood) for the mother during and after pregnancy. When a woman was in the last trimester, the man would ready some rams for slaughter after delivery.

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Providing water in Naibor: building businesses in return

This post was written by Loretta Pilla, an Australian volunteer who is currently working in Kenya as a Program Management Officer with Anglican Overseas Aid’s The Road Less Travelled project.

Jchabure Lengunya is a mother of six children between four and 16 years of age. In addition to her family responsibilities, she is also an active member of the Naibor Water Committee. With Jchabure’s youngest child wrapped tightly around her neck, we sit beneath the shade of an acacia tree 50 metres uphill from the recently built rock water catchment in Naibor group ranch, in Laikipia County of Kenya.

“We are now entering the wet season,” she explains, pointing at the vast red clay landscape stretching to the horizon. It is barely flecked with green foliage, with even less houses in between.

Before the water catchment was built the women of Naibor travelled long distances during the wet season to the Naibor open spring to dig for water, and even further during the dry season to the Nanyuki River.

Image: Loretta Pilla / Anglican Overseas Aid

Women of Naibor in Laikipia, Kenya, wait to collect water from the tank at the base of the rock water catchment built by the community with support from The Road Less Travelled project. Image: Loretta Pilla / Anglican Overseas Aid

Jchabure explains that the water committee is responsible for ensuring the sustainable use of water by community members. This is an important role given the pressures the harsh weather conditions and often extended dry seasons can have on water availability.

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The work of the community

This post was written by Chris McKeon, Writer and Production Assistant at Arete Stories.

About three hours north of Nairobi around a high, rocky hill is a collection of small huts. They are part of the Maasai community of Naibor, in Kenya’s Laikipia region.

As well as the mud huts, there is also a small primary school built of metal sheeting and a track, carved through the red dust, linking it to the towns of Nanyuki and Doldol. The odd goat grazes along the side of this track and women can be seen trudging through the red dust daily with water containers on their backs. The lack of water in the community becomes increasingly apparent the closer one gets.

The dusty track that links the Maasai community of Naibor to the towns of Nanyuki and Doldol.  Image: Matthew Willman / AOA

The dusty track that links the Maasai community of Naibor to the towns of Nanyuki and Doldol.
Image: Matthew Willman / AOA

“We were in difficulties with water,” explains James Supa as he sits on a rock near the roadside. “In the dry season, mothers have to walk to the river or Doldol or Nanyuki for water. It can take a whole day to fill their buckets with water.” (Read our earlier blog post about the effects of the water burden on women in Naibor.)

The little water they do find is often contaminated by animals or can only be reached by digging in the mud where the river used to flow, five kilometres from Naibor. Supa acts as a link person between The Road Less Travelled project (TRLT) and the Maasai, to ensure any development activities are locally-appropriate and meet the needs of the community. TRLT is a project of Anglican Overseas Aid, which works in partnership with local organisation the Mothers’ Union of the Anglican Church in Kenya (MUACK).

In Naibor, the community identified the chronic water shortage as a key development challenge.  Image: Matthew Willman / AOA

In Naibor, the community identified the chronic water shortage as a key development challenge.
Image: Matthew Willman / AOA

Women of Naibor at a community meeting. The new rock catchment will mean less time walking long distances to collect water for their households.  Image: Matthew Willman / AOA

Women of Naibor at a community meeting. The water shortage is a burden that is felt most heavily by women, whose task it is to walk long distances on a daily basis to collect their household’s water.
Image: Matthew Willman / AOA

The past few years have seen increasingly long dry spells in the Laikipia region, and the water shortages have worsened. When TRLT started and a community development committee was formed, the people of Naibor identified the chronic water shortage as a key challenge, and appealed for support from the project to alleviate the problem.

After community discussions, the suggestion was made to use the local environment and build a rock water catchment to store water during the rainy season. TRLT supported the initiative, which made use of local labour and resources to build two low walls along the hill’s bare rock face, as well as a storage tank. The walls channel the rainwater down the rock face and into the tank for use during the long dry season, when water is scarce.

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On the road to safer birthing practices

This post was written by Sarah Manyeki, Monitoring & Evaluation Officer for Mothers’ Union Kenya – Anglican Overseas Aid’s partner in The Road Less Travelled project.

In the remote Maasai community of Morupusi, in Kenya’s Laikipia County, the training and deployment of Community Health Workers (CHWs) is beginning to see positive results. Elizabeth Kaparo was trained as a CHW in 2012, an initiative of The Road Less Travelled (TRLT), a project that is committed to improving access to basic health care for nomadic pastoralist communities.

CHWs, people trained in basic health skills and who live within the nomadic pastoralist communities, are part of the Kenyan Ministry of Health’s (MoH) strategy to find local solutions to the barriers to accessing health services. TRLT partner the Mothers’ Union works with the MoH to facilitate the training of CHWs. This collaboration is an important step to bridge the gap between the traditional practices of these communities, and formal health facilities.

The efforts of TRLT-trained Community Health Workers are starting to have a positive effect on the health of mothers and children in the Maasai community of Morupusi.  Image: Matthew Willman / Anglican Overseas Aid

Mothers and children in the Maasai community of Morupusi are starting to benefit from the training of Community Health Workers, who provide a link between traditional practices and formal health services.
Image: Per Arnsäter / Anglican Overseas Aid

The project envisages the CHWs as a vital asset to their community, offering a cost-effective, accessible, and community-owned health resource.

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Educate a girl, educate a community

This post was written by Sarah Manyeki, Monitoring & Evaluation Officer for Mothers’ Union Kenya – Anglican Overseas Aid’s partner in The Road Less Travelled project.

In the pastoralist communities of Kenya, there are several factors that limit women’s participation in safe motherhood practices, with the substantive factor being illiteracy. In Laikipia County, where the project works, 40 per cent of men are literate in Swahili while barely 25 per cent of women are. In Samburu County, 30 percent of men are literate while only 15 percent of women are. Figures for English literacy are even lower. Illiteracy not only inhibits mothers from reading and understanding their children’s clinic cards, prescriptions, and nutritional advice, but it also lowers their confidence and increases difficulties in understanding – much less applying – legal rights.

Suzan is working hard to change this. She is one of four female Community Development Committee (CDC) members elected to represent the Chumvi Group Ranch in Laikipia County, Kenya. The CDC was formed in March 2012, with the support of The Road Less Travelled project. Suzan is one of the few Maasai women from this community who has been fortunate to have the opportunity to participate in education up to the secondary school level.

Suzan is one of the few women in her community who has been fortunate to have access to education; now she has started a literacy education class for other women in her community.  Image: James Senjura / MUACK

Suzan is one of the few women in her community who has been fortunate to have access to education; now she has started a literacy education class for other women in her community.
Image: James Senjura / MUACK

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Community at the core of development

This post was written by Mothers’ Union Project Officers in Kenya, James Senjura (Laikipia) and Sarah Lansanyane (Samburu), and Africa Program Advisor for Anglican Overseas Aid, Phillip Walker.

At the heart of The Road Less Travelled’s (TRLT) community development work in Kenya are the Maasai and Samburu nomadic pastoralists. The project uses a strength-based approach, which is based on the understanding that each community has its own skills and assets, and often unrealised potential, which can assist them in identifying and achieving solutions to the challenges they face. While certain activities require specialist facilitation and access to external expertise, the aim is for all members of a community to become central in making the decisions that affect their lives. This puts them in a position to drive their own development agenda.

In Kenya, the communities TRLT works with have some history of engagement with aid organisations and consequently hold expectations of financial handouts to solve ‘problems’. Previous interventions have mostly, not completely, been based upon an outside agency providing resources and expertise, with the community making a counterpart contribution, usually labor. Any project committee formation has been non-inclusive and short-term; that is, lasting only until the project is completed. Often the existing (predominantly male) power structures have filled the role of a project committee.

For The Road Less Travelled, the formation of inclusive Community Development Committees (CDCs) is a cornerstone of the project. This represents a significant change process in itself for these communities, as for the first time they have an inclusive developmental structure to voice their issues.

Daniela, a TRLT Link Person in Samburu, Kenya, meets with the Community Development Committee twice a month to discuss their development priorities and progress.  Image: Matthew Willman / Anglican Overseas Aid

Daniela, a TRLT Link Person in Samburu, Kenya, meets with the Community Development Committee twice a month discuss their development priorities and progress.
Image: Matthew Willman / Anglican Overseas Aid

Before the CDCs were formed, the TRLT Project Officers visited each community, obtaining permission from authorities and traditional leaders to proceed. They held meetings to discuss the project and its aims, along with the role and function of the committee, and the criteria for its formation. This process culminated in a community wide meeting where the CDC was elected.

At least 40 per cent of the CDC must be women; however this is an inadequate measure, given that cultural norms often result in women remaining silent and deferring to males for key decisions. To combat this, the project team has been working patiently to strengthen the confidence and ability of elected women to take active leading roles, as well as promoting women who already have the confidence to challenge male authority. Literacy training has helped women overcome the constraints that prevent them from being actively engaged when minutes are taken or written materials distributed.

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Baseline Report offers important insight into maternal and child health among nomadic pastoralist communities

Between January and May in 2012, The Road Less Travelled (TRLT) project undertook a maternal and child health (MCH) baseline survey among Maasai and Samburu nomadic pastoralist communities in Laikipia and Samburu, Kenya.

The purpose of this baseline assessment was to understand the existing context and situation prior to the implementation of TRLT project initiatives in Kenya, and to identify the current status of key thematic areas that impact on MCH outcomes among nomadic pastoralists.

TRLT AACES Baseline Report

Maternal and child health baseline survey among Maasai and Samburu nomadic pastoralist communities in Laikipia and Samburu, Kenya.

A broad holistic strengths-based approach was adopted during the design of the project to include a focus on the key determinants of health. The thematic areas captured in the baseline study reflect this focus, and include:

  • Knowledge, attitudes and practices in relation to core MCH indicators;
  • Family planning
  • Disease and immunisation;
  • Access to health services;
  • Access to literacy and education;
  • Water, sanitation and hygiene (WASH); and
  • Livelihoods.

A quantitative questionnaire was administered to 800 pastoralist households across Laikipia and Samburu. The questionnaire was administered to a man and a woman from each of the participating households. Qualitative data was also captured via a series of focus group discussions with men, women and traditional birth attendants.

The findings allow for a deeper understanding of the knowledge, attitudes and practices regarding MCH and other issues impacting on health in these communities. This data will be used to inform The Road Less Travelled’s project strategy and set baseline evaluation indicators by which impact and change in the communities will be measured over time.

Download the full report

Easing the water burden

This post was written by Greg Armstrong, Research Fellow at the Nossal Institute for Global Health, Anglican Overseas Aid’s partner in The Road Less Travelled project.

We met Natana Nalikite and Kumontaare Mayani by an open spring in Naibor, a Maasai group ranch in Laikipia County, Kenya. A rock water catchment is being built nearby to ease the water burden on the local community. It is a burden that is felt most heavily by women, whose task it is to walk long distances on a daily basis to collect their household’s water. Our recent baseline survey in Naibor found that 77 percent of women walk two or more hours per day to fetch their household’s water supplies.

The women of Naibor walk long distances every day to reach the open spring, where they place their containers in a queue and wait for their turn to collect their household’s water.
Image: Greg Armstrong

Natana is in her 40s, a mother of five and the only wife to her husband. Her youngest child, a six month old girl named Sawaoi, is cradled in a sling that sits around her shoulders. Her surname, Nalikite, means to walk slowly, yet Natana assures us that she has greater strength in her legs than her name suggests.

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Bridging the gap in maternal health care for Kenya’s Maasai

This post was written by Sarah Manyeki, Monitoring & Evaluation Officer, and Millicent Wanjiru, HIV Project Officer, for Mothers’ Union – Anglican Overseas Aid’s Kenyan partner in The Road Less Travelled project.

Traditional birth attendants (TBAs) are a sensitive topic in Kenya. They are proscribed because they were believed to have been contributing to the nation’s high maternal and child mortality rates.

Despite the TBAs being proscribed, they still play a very major role in assisting mothers to deliver in remote nomadic pastoralist communities. According to a Baseline Survey carried out by Mothers’ Union between January and May 2012, 92 percent of women in Laikipia and Samburu Counties give birth at home without the assistance of a skilled health worker.

TBA

In safer hands: could empowering traditional birth attendants be the key to bridging the health care gap for Kenya’s nomadic pastoralist communities?
Image: AVI / Hannah Ford

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Representing marginalised communities at a global level

The Road Less Travelled project partners will take to the stage at the Global Maternal Health Conference next month, to represent the nomadic pastoralist communities the project works with in Ethiopia and Kenya.

The conference, which is being held in Tanzania from 15-17 January 2013, brings together scientists, researchers, and policy-makers from all over the world to network, share knowledge, and build on progress toward eradicating preventable maternal mortality and morbidity by improving the quality of care.

Valerie Browning, Australian midwife and founder of the Afar Pastoralist Development Association (APDA), will be part of a panel presenting strategies to eliminate barriers to skilled birth attendance.

Valerie Browning (right) will be a panellist at the Global Maternal Health Conference in January 2013, presenting the Afar Pastoralist Development Association’s strategy for safe motherhood to a global audience.
Image: Anglican Overseas Aid

Recognising the important role of Traditional Birth Attendants (TBAs) in maternal and child health development in pastoralist communities, APDA is working with TBAs, communities, and local governments to reduce maternal and newborn mortality in Afar region of Ethiopia. Valerie will share APDA’s community-level strategy for safe motherhood in her presentation titled “Trained traditional birth attendants: Today’s missed opportunity”.

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