Kilifi seeks to end risky abdominal massage on pregnant women

Indian lawyer and nationalist Mahatma Gandhi is quoted as saying.“A nation’s culture resides in the hearts and in the soul of its people.”

While culture represents a rich past that needs to be carried forward, some retrogressive practices can be harmful to the unborn.

This is the situation in some parts of the coastal county of Kilifi.

Despite explicit warnings from health professionals, eight out of 10 pregnant women who show up at the Rabai Sub County Hospital undergo traditional abdominal massage.

Hospital data indicates that despite attending antenatal clinics (ANC) for health talks, majority of expectant mothers opt for abdominal massage, influenced by cultural norms and familial advice.

“Abdominal massage is a prevalent choice among women here. Educated or not, many believe in its benefits despite knowing the associated dangers,” says Loice Matho, the nurse in charge of Rabai Hospital’s maternity wing.

Before undergoing the massage, pregnant women are briefed on the risks during ANC sessions.

Yet, influenced by cultural pressure and familial advice, the women often seek traditional birth attendants for this practice.

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The consequences, as Matho says, can be devastating. They range from premature labour to stillbirths. The toll on maternal and infant health is profound.

One such tragic case is Mwanajuma Ndegwa’s, who recounts her journey of acute abdominal pain and eventual stillbirth that was linked to complications from abdominal massage.

Grimacing in pain, tears dripping from her eyes, she narrates her pregnancy journey and how she prepared to welcome her third-born child.

She was admitted to the facility on June 7, 2024, with acute abdominal pain and excessive bleeding.

Sadly, the tests indicated that the foetus had died. She was in her eighth week.

“It pains me to have lost my pregnancy. I came here expecting to cuddle my baby, only to walk out empty-handed,” narrates Mwanajuma.

“I was so excited to have a girl as my two children are boys, only for the joy to be cut short by miscarriage. I received the news of the baby’s death with a heavy heart,” she told this writer.

Health professionals at the facility link the death to abdominal massage, claims Mwanajuma denies.

However, she admits to having undergone this practice during the pregnancy of her second-born son.

Health professionals stress urgent need for cultural reforms.

Despite extensive sensitisation efforts, including community dialogues and educational campaigns, this traditional practice remains.

Choni Chigulu, the reproductive health coordinator in Rabai sub-county, says recent health records show a notable percentage of neonatal deaths in Kilifi caused by abdominal massage. This underscores the critical imperative for informed decision-making among expectant mothers.

Data shows that at least 20 per cent of neonatal deaths in the last quarter (January to March), were attributed to the massage.

“About six out of 20 deaths reported were due to traditional massage. Abdominal massage is real,” says Chigulu.

She attributes the practice to a lack of information, peer or social influence and ignorance.

“Most women are not empowered to make their own decisions. Some women I meet tell me that they experienced pain, and their mothers-in-law advised them to go to a traditional birth attendant,” Chigulu says.

Chigulu says when a pregnant woman is massaged, especially when they are at term, it interferes with the normal functioning of the baby in the uterus.

The baby is therefore born already stressed, dies in the uterus or scores poorly at birth.

Apart from dangers caused to babies, mothers risk uterus raptures that cause post-partum haemorrhage and death.

“Abdominal massage brings about preterm, macerated (when baby dies in the uterus and begins to rot), stillbirth, and a compromised baby who develops cerebral palsy,” adds Chigulu.

“Cases of neonatal deaths, including fresh births and macerated stillbirths, have been high in the past four years,” explains Kilifi County Director of Health Hassan Leli.

In the same period, we have recorded at least 1,876 cases of macerated stillbirths.

Highest numbers

The highest numbers were reported in 2021 with 531 cases, followed by 2020, 2022, and 2023 with 453, 484, and 408 cases respectively.

 “It is very hard to break a culture. Women just believe they have to go to the traditional birth attendants,” Daisy Juma, the doctor in-charge of Rabai Hospital, says.

In the traditional massage, Dr Juma adds, the risk of ruptured placenta and strangulation of the baby is high.

“If a baby is at the corner of the womb, and they have massage around the neck it can cause foetal demise,” says Juma.

Data shows that in the last four years, fresh stillbirths totalling 1,704, have been reported.

Additionally, there is a concerning trend of premature births; with 1,675 reported last year alone, a slight drop from 1,765 in 2022.

Zainabu Lwambi, a retired traditional birth attendant from Mazeras, recalls her days when she plied her trade for decades with nostalgia.

“My hands are blessed,” she says with a tinge of satisfaction.

This story was made possible with the support of the UZIMA-DS project, funded by the National Institutes of Health (NIH).