Priscilla Christopher-Akpanettot
Despite high antenatal care (ANC) attendance at public health facilities, many pregnant women in Akwa Ibom State still turn to Traditional Birth Attendants (TBAs) for childbirth, exposing themselves to preventable complications, including postpartum haemorrhage (PPH), and the risk of maternal death.
To bridge this gap between antenatal care and skilled delivery, the Akwa Ibom State Ministry of Health, in partnership with the Solina Centre for International Development and Research (SCIDaR), has adopted a community-based intervention designed to rebuild trust in the formal healthcare system and encourage more women to deliver in health facilities.
The initiative emerged from a one-day co-creation meeting in Uyo, convened under the Postpartum Haemorrhage (PPH) Catalytic Opportunity Fund Project, where stakeholders resolved to pilot the Community Reorientation Women Network (CRoWN) model in Oruk Anam Local Government Area.
The model seeks to leverage the influence of trusted women within communities to identify pregnant women, promote birth preparedness, encourage skilled delivery and facilitate timely referrals to health facilities.
Oruk Anam has been selected as the first local government area in the state to pilot the initiative, with stakeholders from government, health facilities, traditional institutions, churches and women’s groups participating in discussions on how best to adapt the model to local realities.
The Commissioner for Health, Dr. Ekem Emmanuel John, said the state had recorded progress in strengthening maternal healthcare, including the development of its Essential Medicines List and the training of health workers in the prevention and management of postpartum haemorrhage.
He, however, noted that the continued preference for Traditional Birth Attendants by some pregnant women remained a major challenge to maternal survival, despite their contact with the formal healthcare system during antenatal visits.
Dr. John commended SCIDaR for its support and emphasised the need to extend interventions beyond hospitals and primary healthcare centres to the communities where families make critical decisions about childbirth.
He maintained that achieving better maternal health outcomes required a coordinated approach that addressed not only the availability of healthcare services but also the social, cultural and practical factors influencing women’s choices.
The Executive Secretary of the State Primary Health Care Development Agency, Dr. Eno Attah, echoed this position, stressing that the success and sustainability of the CRoWN model would depend on its relevance to the state’s diverse communities.
She said the intervention must reflect local cultures, needs and regional differences to secure community acceptance and ensure lasting impact.
Providing further insight into the challenge, the Ministry of Health’s PPH Project Desk Officer, Dr. Edidiong James, identified the absence of health workers at some primary healthcare centres during night hours, the cost of delivery services and entrenched cultural beliefs as factors contributing to the continued patronage of TBAs.
According to him, these barriers often undermine the benefits of antenatal care, as women who regularly attend hospital appointments may still opt for traditional birth attendants when labour begins.
He called for stronger collaboration among government agencies, healthcare providers, community leaders and women’s groups to identify and address the obstacles discouraging facility-based deliveries.
The concerns highlight the need for a maternal healthcare strategy that combines improved service delivery with community engagement, ensuring that pregnant women can access skilled birth attendants when and where they need them.
Explaining the operational framework of the initiative, SCIDaR Team Lead, Masturah Baba, said the CRoWN model would rely on respected women volunteers, known as CRoWN Ambassadors, who live within the communities they serve.
Rather than depending solely on health workers to reach pregnant women, the ambassadors will use their established relationships and influence to identify expectant mothers early, educate families on birth preparedness, promote skilled delivery and follow up on referrals to ensure women are not lost along the continuum of care.
Baba said the model had recorded encouraging results in some northern states, expressing optimism that similar outcomes could be achieved in Akwa Ibom through effective implementation and strong community ownership.
She explained that trusted community women could play a crucial role in changing perceptions, addressing misconceptions and helping families recognise the importance of delivering in health facilities where trained personnel and emergency interventions are available.
The Project Director of SCIDaR, Dr. Chukwunoso Nwaokorie, also underscored the importance of sustained collaboration between government and development partners in ensuring that pregnant women receive timely and appropriate care.
Similarly, the Project Manager, Dr. Chinedu Obikeli, disclosed that the media campaign supporting the initiative would be integrated into existing Ministry of Health programmes to reinforce positive health-seeking behaviour and increase public awareness of the importance of skilled childbirth.
The CRoWN initiative represents an effort to address one of the persistent challenges in maternal healthcare: ensuring that women who access antenatal services also deliver under the supervision of skilled health professionals.
If successfully implemented in Oruk Anam, the model is expected to be expanded to other local government areas, complementing existing state interventions aimed at reducing preventable maternal complications, including postpartum haemorrhage and eclampsia.
Its long-term success will depend not only on the commitment of community ambassadors but also on the readiness of health facilities to provide accessible, affordable and reliable services, particularly during emergencies and at night.
For Akwa Ibom, the pilot offers an opportunity to strengthen the link between communities and the formal healthcare system, with the ultimate goal of ensuring that no woman dies from a preventable complication of pregnancy or childbirth.
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