Nomme Kodjoukalo-Pitikalo is a midwife in Togo. She explains what has changed since health staff began working with the principles of respectful maternity care.
IAMANEH Switzerland: Mrs. Pitikalo, is it true that some women in Togo avoid giving birth in hospital because they fear disrespect, mistreatment by medical staff, or are simply afraid of the atmosphere in the maternity ward?
Nomme Kodjoukalo-Pitikalo: Yes, that’s absolutely true.
And do you think this fear is justified?
It is justified. Until recently – and in some places still today – women often received little or no attention when they arrived. Trust between staff and patients was lacking. Women feared not being able to give birth in the way that felt right for them. So many chose to deliver at home.
Why does this happen?
Mainly because of staff shortages and the heavy workload of midwives. Facilities are also often poorly equipped. A survey showed that many women stayed away from hospitals because they were not allowed to choose their birthing position. At home they could squat, hold on to something, or move as they wished. In hospital, until recently, they were told to lie on their backs on the delivery table.
What are the consequences?
With so many unattended home births, women only reached us in critical condition when complications arose. At that stage, all we could do was transfer them to a better-equipped hospital. Sometimes it was already too late.
AFAD promotes “respectful maternity care” to encourage women to seek health facilities earlier. As a midwife, you are part of this change. What has it meant for you?
The introduction of respectful, humanized childbirth has transformed our work. The number of home births has dropped sharply, while more and more deliveries are now taking place in hospitals, thanks to this new approach.
Learn more about the AFAD and IAMANEH project in Togo:: Respectful Maternity Care
What exactly has changed?
When women arrive, we explain what to expect. We show them pictures of different birthing positions. We now have ropes, birthing balls, the Maya birthing stool, and a modern multifunctional delivery table. Women can see all of this and choose what suits them best. On the day of delivery, everything runs more smoothly because we have prepared together.
Have you also witnessed births where the mother’s needs were not respected? What was that like for you?
Yes. In the past, I too conducted deliveries where mothers had no choice. Every woman had to lie on the delivery table. We were taught that the supine or left lateral position was best. But I noticed that births in those positions often took much longer compared to the options we now offer. With respectful maternity care, births are shorter and easier. The women notice this as much as we do.
Have you received feedback from mothers?
Yes, very often. Women tell their friends: “My earlier birth lasted too long, but this time it was so much easier.” That word of mouth is one reason why more women are now coming to us.
What motivates you in your profession and in driving these changes?
What motivates me is doing my job well. When I see a mother leaving the hospital with her baby and a smile, when I see fathers proud and happy – that gives me joy. Later, when I meet these families, they tell me they are satisfied. That makes me proud. They also come to me with other issues and ask for advice. Communication has improved greatly, and that is very rewarding.
The interview was conducted in writing and in French. Questions by Miriam Glass.
