Health officials in Kabale District have raised significant concerns regarding the continued reliance on traditional birth attendants (TBAs) by expectant mothers, warning that this persistent practice is a primary driver of preventable maternal and newborn deaths within the Kigezi sub-region. Paddy Patrick Mwesigye, the Kabale District Assistant Health Officer, revealed that approximately 17 percent of expectant mothers in the district still opt to deliver under the care of traditional birth attendants rather than seeking professional services from accredited and equipped health facilities. This trend persists despite extensive government efforts to decentralize maternal healthcare and provide specialized medical services at the grassroots level.

Speaking in a detailed interview with the Nile Post, Mwesigye emphasized that deliveries conducted outside the formal healthcare system frequently expose both mothers and their infants to life-threatening complications. The fundamental issue, according to health authorities, is that traditional birth attendants lack the formal medical training, sterilized equipment, and pharmaceutical resources necessary to manage emergency obstetric situations. In a formal clinical setting, skilled medical personnel are trained to identify early warning signs of distress, but in the domestic settings where TBAs operate, these signs are often ignored until it is too late for effective intervention.

The situation in the Kigezi sub-region, characterized by its rugged terrain and remote villages, exacerbates the dangers of home-based deliveries. Mwesigye noted that many of the newborn deaths recorded in the region are directly linked to these non-formal deliveries. When a complication arises—such as a postpartum hemorrhage, obstructed labor, or neonatal asphyxia—the lack of immediate emergency obstetric care becomes a fatal hurdle. By the time a traditional birth attendant realizes that a situation is beyond their control, the window for life-saving medical intervention has often closed.

The Critical Danger of Late Referrals

A recurring theme in the mortality audits conducted by the district health office is the "late referral" phenomenon. Mwesigye explained that many traditional birth attendants only advise families to seek hospital care after a complication has reached a critical or irreversible stage. This delay is frequently the difference between life and death. When mothers finally arrive at accredited health facilities, they are often in profound shock, suffering from massive blood loss, or dealing with advanced infections, making it exceptionally difficult for even the most skilled medical teams to stabilize them.

“By the time these mothers reach health facilities, they are often in critical condition, making it difficult for medical personnel to save either the mother or the baby,” Mwesigye stated. He noted that the transition from a home delivery to a hospital emergency often involves navigating difficult transport routes, further wasting precious minutes. The reliance on TBAs creates a false sense of security for families, who may believe they are in safe hands until the mother’s health deteriorates rapidly.

Historical Context: The 2010 Ban and the Persistence of TBAs

The challenge facing Kabale District is part of a broader national struggle in Uganda. In 2010, the Ugandan Ministry of Health officially banned traditional birth attendants from conducting deliveries, citing their inability to handle complications like hemorrhaging, which remains the leading cause of maternal death in the country. Under the national policy, TBAs were repurposed as "referral agents," tasked with encouraging mothers to visit health centers and accompanying them to facilities for skilled care.

However, despite this legal and policy shift over a decade ago, the practice remains deeply entrenched in rural communities. The reasons for this persistence are multifaceted. In many parts of the Kigezi sub-region, TBAs are seen as trusted community figures who offer emotional support and cultural rituals that formal hospitals may lack. Furthermore, some mothers cite the perceived "harshness" of formal medical staff or the hidden costs of "mama kits" and transport as reasons to stay away from health centers.

Mwesigye questioned the logic of bypassing government facilities, pointing out that the state has invested heavily in improving maternal and child healthcare services. Across the region, health facilities have been upgraded and equipped with skilled midwives, essential medicines, and modern equipment capable of handling both routine deliveries and complex emergency cases, including Cesarean sections at Health Center IVs and hospitals.

Supporting Data and the "Three Delays" Model

The maternal mortality ratio in Uganda, while improving over the last two decades, remains a concern for health planners. According to the Uganda Demographic and Health Survey (UDHS), maternal mortality stands at approximately 336 deaths per 100,000 live births. While this is a significant drop from previous years, the target is to reduce this to below 70 per 100,000 to meet the United Nations Sustainable Development Goals (SDGs) by 2030.

Public health experts analyze these deaths through the "Three Delays" model, all of which are present in the Kabale context:

1. Delay in deciding to seek care: Often caused by a lack of understanding of danger signs or the influence of traditional birth attendants.
2. Delay in reaching a health facility: Exacerbated by the mountainous terrain of Kigezi and poor transport infrastructure in rural sub-counties.
3. Delay in receiving adequate care at the facility: Though Mwesigye notes that facility readiness has improved, the "first delay" remains the most significant hurdle in the 17 percent of cases involving TBAs.

The 17 percent figure cited by Mwesigye represents thousands of women across the sub-region who are essentially gambling with their lives. In a district where the population is growing, the pressure on health systems to capture every pregnancy within the formal net is higher than ever.

Government Investment and Infrastructure Improvements

In response to these challenges, the Ugandan government, through the Ministry of Health and local government structures, has focused on the "Health Sector Integrated Development Plan." In Kabale and surrounding districts like Rubanda and Rukiga, this has manifested in the upgrading of several Health Center IIIs to include maternity wards and the stabilization of Health Center IVs as functional emergency surgical units.

Mwesigye highlighted that these facilities are now better staffed than in previous years. The recruitment of more midwives and the consistent supply of oxytocin (to prevent bleeding) and antibiotics (to prevent sepsis) have made facility-based delivery safer than it has ever been in the region’s history. The government has also distributed "Mama Kits"—packages containing basic delivery supplies like plastic sheets, razor blades, and cotton wool—to ensure that poverty is not a barrier to seeking professional care.

Despite these tangible improvements, the "human element" of cultural preference continues to hinder progress. Health officials are now calling for a shift in community mindset, urging local leaders and Village Health Teams (VHTs) to take a more proactive role in monitoring pregnant women in their villages and ensuring they attend at least eight antenatal care (ANC) visits as currently recommended by the World Health Organization.

Broader Impact and Social Implications

The implications of maternal death extend far beyond the individual tragedy. When a mother dies during childbirth in a community like Kabale, the socio-economic stability of the entire family is threatened. Newborns who lose their mothers are significantly less likely to survive their first year of life. Furthermore, older children in the household often face malnutrition, loss of educational opportunities, and long-term psychological trauma.

From an economic perspective, maternal mortality represents a loss of productivity and puts an additional strain on the social fabric of the Kigezi sub-region. There is also the issue of maternal morbidities; women who survive a poorly managed delivery by a TBA may suffer from long-term complications such as obstetric fistula, secondary infertility, or chronic pelvic pain, which further diminishes their quality of life and ability to contribute to the local economy.

The Assistant Health Officer’s call to action is not merely a medical directive but a plea for community survival. By embracing facility-based deliveries, communities can ensure that the next generation of Kigezi residents is born in a safe, controlled environment where medical science can intervene when nature falters.

Future Outlook: Strengthening the Referral Chain

To bridge the gap, Kabale District health officials are looking toward a more integrated approach. This includes strengthening the role of Village Health Teams to act as the eyes and ears of the formal health system. By identifying pregnant women early in their first trimester, VHTs can provide the necessary education to steer families away from TBAs and toward the nearest health center.

There is also a growing discussion about the need for stricter enforcement of the ban on TBAs practicing medicine, while simultaneously finding ways to involve them as "birth companions" who provide emotional support without performing medical procedures. This "hybrid" approach has seen success in other regions of Sub-Saharan Africa, where traditional figures are incentivized to bring mothers to hospitals rather than hide them in homes.

Mwesigye concluded by urging all stakeholders—including religious leaders, traditional chiefs, and local politicians—to use their platforms to promote hospital births. He reiterated that the goal is not to disparage traditional figures but to ensure that the sanctity of life is protected through the use of modern medical expertise. The wellbeing of mothers and children in Kigezi depends on a collective transition from outdated practices to the safety of the modern clinical room. As the district continues to monitor the 17 percent of outliers, the message remains clear: a hospital delivery is not just a preference; it is a life-saving necessity.