In Bocanda, in the center-east of Côte d’Ivoire, maternity figures are rising: 866 deliveries recorded at the Établissement public hospitalier départemental (EPHD) by the end of September 2026, compared to 657 during the same period in 2025, representing an increase of more than 30%. Among them, 110 caesarean sections were performed, with no maternal deaths recorded. A record that the director of the establishment, Dr Déh Urbain, describes as satisfactory — but which conceals a worrying reality: some deliveries continue to take place outside the hospital walls, in the hands of traditional birth attendants, with serious risks for mothers and newborns.
Complications arriving too late
It was during the 3rd annual session of the departmental committee to combat maternal, neonatal and infant mortality, held on 8 October 2026 at the prefecture of Bocanda, that Dr Déh put precise words to a recurring problem. According to him, traditional birth attendants — known as matrones — who accompany deliveries tend to manage labor until a critical stage before referring the patient to the hospital. “These matrones, thinking they can handle the delivery, push labor to its extreme point, and when these women arrive at the hospital, very often we lose the baby, and the mothers are in great danger,” he declared.
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The clinical picture described is one of severe obstetric complications: hemorrhages, dystocias, neonatal distress. All situations that, if managed too late, can be fatal. While no maternal deaths have been recorded to date in the department according to EPHD data, the medical director emphasizes that this is more a result of the mobilization of hospital teams than the absence of emergency situations.
No opposition, but a collaboration to build
The tone chosen by Dr Déh is one of dialogue, not sanction. Rather than stigmatizing the matrones or sidelining them, he advocates for structured exchange sessions aimed at helping them identify their own technical limitations. “We need to help them recognize the moment when they should hand over, in order to avoid home deliveries. We all share a single objective: the lives of the mother and child,” he concluded.
This approach is not without significance. In many rural areas of sub-Saharan Africa, matrones play a proximity role that the formal health system does not always manage to fulfill, due to lack of staff or geographical accessibility. Excluding them from the system without integrating them would create a void that other practices, potentially even less regulated, would come to fill. Regulated coexistence between traditional knowledge and modern medicine is therefore a public health policy issue, not merely a matter of individual goodwill.
A mobilization that goes beyond the medical profession alone
The secretary-general of the prefecture, Zéréhoué Wincedi épouse Seri Bi, who chaired the session, broadened the call well beyond health professionals. Traditional chiefs, religious leaders, local elected officials, community leaders: all are called upon to relay awareness messages and encourage women to give birth in approved facilities. This social dimension is crucial: in certain communities, home birth remains an entrenched cultural norm, or even a matter of modesty or trust in the hospital institution.
The communiqué does not detail the human or material resources of the EPHD, nor the travel times to the hospital from the most remote villages in the department — factors that are nevertheless decisive in understanding why women choose, or are compelled to choose, home delivery. The question of healthcare supply itself — availability of midwives, hours of operation, cost of procedures — remains unaddressed in this call for behavioral change.
What the figures from Bocanda nonetheless illustrate is a real dynamic: the increase in the number of hospital deliveries is tangible. It remains to be seen whether the announced consultation with the matrones will translate into formal mechanisms — training, referral, shared protocols — or whether it will remain a wish expressed in a committee session.
Source: Agence Ivoirienne de Presse (AIP), 12 October 2026
