Maternity Care Through a Cultural Lens: Advocating for Women's Health

Maternity care work in Tanzania requires navigating the space between cultural sensitivity and advocacy for underprivileged women in a problematic space; which is both complex and deeply interconnected. It requires an understanding of not just health-related challenges but also the broader socio-cultural and economic factors that shape women's lives. When working in maternal healthcare, we are often faced with navigating sensitive cultural dynamics while ensuring that women receive the best possible care in settings where resources are limited and traditional practices prevail.

 The Importance of Cultural Sensitivity

Cultural sensitivity is crucial in healthcare settings, especially in a country like Tanzania, where a diverse range of ethnic groups, languages, and traditions shape how women experience pregnancy and childbirth. Cultural beliefs about fertility, pregnancy, birth, and motherhood are often intertwined with spiritual or religious practices. In many Tanzanian communities, birth is seen not only as a physical process but as a deeply spiritual and communal event, with practices passed down through generations. For example, local midwives or traditional birth attendants (TBAs) may play a central role, especially in regions where medical clinics are inaccessible.

When we enter such spaces, we bring with them us medical knowledge and practices, but this needs to be balanced with an understanding and respect for the local customs. A lack of cultural sensitivity can lead to mistrust, where women may feel alienated or judged for their beliefs. For example, insisting that a woman abandon a traditional birth practice without explaining why it might not be safe could result in her disengaging from healthcare services altogether. Instead, a culturally sensitive approach would involve engaging in conversations, understanding her perspective, and gently introducing safe alternatives that align with her values and experiences.

Women’s Empowerment 

Women's empowerment and maternal/obstetrics/gynaecology care are aligned in Medi Trip's work, as they both aim to improve the health and well-being of women and their families. By collaborating in maternal and obstetric care services, we are enhancing access to quality healthcare for women, which is crucial for reducing gender disparities, maternal and infant mortality rates. Empowering women through education about their health, giving them agency over their bodies, promoting safe childbirth practices, and providing prenatal care not only improves health outcomes but also fosters women's confidence in making informed decisions regarding their own lives. Furthermore, by engaging with local communities, we want to help shift cultural norms and attitudes towards women’s health, thereby strengthening the role of women as key players in their communities.

This synergy between women's empowerment and maternity care creates Medi Trip’s holistic approach to advancing women's health in Tanzania.

Advocacy through Education and Empowerment

Effective advocacy for underprivileged women involves not just providing direct care, but also empowering women through education. Women in rural or impoverished areas may have limited knowledge of maternal health, family planning, or the signs of dangerous pregnancy complications. Many may not seek medical attention during pregnancy or childbirth due to cultural beliefs, lack of knowledge, or mistrust of healthcare systems. In these settings, midwifery volunteers can offer life-saving education, but how this education is delivered is crucial.

A culturally sensitive approach to education involves recognising existing knowledge and beliefs and building on them. Instead of dismissing traditional practices outright, we can explain why certain medical interventions are necessary, using language and metaphors that resonate with the local culture. For instance, explaining how modern practices complement rather than contradict cultural practices can make new knowledge more acceptable. Women are more likely to embrace new health practices when they feel their dignity and beliefs are respected.

 Navigating Gender Dynamics and Social Inequality

Advocating for underprivileged women in Tanzania also means addressing the social and gender dynamics that impact their healthcare. In many communities, gender inequality is a significant barrier to women’s health. There is a large section of women who may have limited decision-making power over their own health or agency over thier own bodies, particularly in patriarchal societies where men or elders control family decisions. This can manifest in delayed care-seeking behaviour, where women need permission from family members or where financial resources are not allocated to maternal care.

We need to understand these dynamics when advocating for women's health. A culturally sensitive advocate works not only with the women but also engages with their families and communities. Educating men and community leaders about the importance of maternal healthcare, and framing it in ways that align with local values, can lead to more supportive environments for women to access care. For instance, emphasizing the importance of a healthy mother for the overall well-being of the family may resonate more in certain communities than focusing solely on the woman's individual health.

The Role of Tradition in Births

In many parts of rural Tanzania, TBAs are trusted members of the community, offering support that often extends beyond childbirth to emotional and spiritual care. TBAs may use herbal remedies, perform rituals, or guide women through pregnancy and labour, based on African traditions passed through generations. For women in rural communities, TBAs can be more accessible than trained medical professionals due to geographical barriers or costs.

Although we have considered it many times, Medi Trip projects in rural maternity clinics alongside traditional birth attendants (TBAs) presents several impracticalities due to cultural and systemic differences in healthcare practices. While TBAs possess invaluable local knowledge and experience, their practices may not align with modern medical protocols, potentially leading to conflicting approaches to maternal care. Additionally, limited access to medical supplies, inadequate infrastructure, and varying levels of training among TBAs can hinder the implementation of standardised care practices. Additionally, they often perform the role of “cutters” in female genital mutilation which brings alot of conflicting values. We try to navigate these challenges with sensitivity and adaptability, fostering respectful collaboration while advocating for best practices in maternal health. This requires a delicate balance of respecting traditional practices while aiming to enhance healthcare outcomes for mothers and infants in these communities.

While TBAs offer critical support, they may not have the medical training to handle complications that arise during childbirth, such as obstructed labor, preeclampsia, or excessive bleeding. Here, midwifery workers must advocate for the integration of modern obstetric care with traditional practices, finding ways to collaborate with TBAs rather than displacing them. Cultural sensitivity means acknowledging the importance of TBAs in the community while gently advocating for practices that enhance safety, such as encouraging referrals to clinics for complicated deliveries or ensuring that basic hygiene standards are maintained during home births.

Building Trust with Communities

Trust is the cornerstone of effective healthcare advocacy in any cultural context. Building trust as an outsider requires time, patience, and humility. We must demonstrate that we are there to support, not to impose their own ideas that come from privileged/educated backgrounds. This can involve simple acts of respect, learning from community leaders and listening to women's stories without interruption and judgment.

Trust is particularly important in communities where healthcare systems or former interventions (such as missionaries) have historically been subpar or exploitative. Some women may be frightened or already had negative experiences with healthcare providers, leading to a lack of confidence in medical interventions. Foreigners must be aware of this history and approach their role as partners rather than authoritative figures. By showing a commitment to the community's well-being and collaborating with local healthcare workers and leaders, volunteers can advocate more effectively for the women they serve.

Navigating Obstetric Violence and Confronting Work Environments as Medi Trip Volunteers

It’s essential to approach the sensitive topic of obstetric violence with awareness, empathy, and respect for cultural nuances. Obstetric violence refers to the mistreatment of women during pregnancy, childbirth, and the postpartum period, and it can manifest in various forms, including physical, emotional, and psychological harm.

Navigating obstetric violence and confronting complex work environments in Arusha require a compassionate and informed approach. Our ability to empathise, listen, and collaborate with local midwives can lead to meaningful changes in maternal health care. By advocating for respectful practices and supporting local initiatives, you’ll play a vital role in empowering women and creating a positive impact within the community.

Challenges and Ethical Considerations

One of the significant challenge is navigating the ethical tension between respecting cultural practices and advocating for evidence-based medical care. For instance, in some areas, early marriage and adolescent pregnancy are culturally accepted, but these practices pose significant health risks. Similarly, the prevalence of female genital mutilation (FGM) in some communities presents a profound ethical dilemma, as it is a deeply rooted cultural practice that endangers women’s health. Volunteers must carefully navigate these issues, advocating for the health and rights of women without alienating the community.

Ethical advocacy involves working towards long-term change while respecting the community's pace of transformation. This may include raising awareness about the health risks associated with certain practices through dialogue and education, supporting local initiatives aimed at ending harmful practices like FGM, and working with government and non-governmental organizations to improve healthcare infrastructure and access.

The intersection of cultural sensitivity and advocacy in midwifery interventions in Tanzania is an ongoing balance of respect, understanding, and empowerment. We can play our part in improving maternal healthcare, but the effectiveness hinges on the ability to work within the cultural frameworks of the communities we serve. By respecting traditional beliefs, collaborating with local healthcare providers, and empowering women through education and support, volunteers can advocate for women in ways that honour their dignity and enhance their well-being. Through this culturally sensitive approach, midwifery volunteers contribute to more sustainable and impactful healthcare outcomes for women in Tanzania.