In sandals made from old car tyres, Leitati Rabikon walks with measured steps, careful not to tread on acacia thorns, up the steep hill in the midday sun. Every so often, she stops to wipe the sweat from her face.

Rabikon, who is in her 80s, arrives with three other women at the home of Kevina Kenyaga, who is heavily pregnant with her fourth child. The four are traditional birth attendants (TBAs) in Leparua, a remote community in Isiolo county, north-east Kenya.

“Huyu atazaa leo [she will give birth today],” Rabikon says in Swahili, while giving Kenyaga an abdominal massage. Kenyaga does have a baby boy at the local clinic later that afternoon.

Kenyaga lives within walking distance of the privately run clinic, funded by the Lewa Wildlife Conservancy, which it borders. The nearest government hospital is 30 miles away in Isiolo town. To get there, a woman takes her chances with bandits – who have made this region insecure – and has to find the money for transport and a hospital stay.

While traditional midwives are key providers of delivery services in rural areas in Kenya and across sub-Saharan Africa, they have been blamed at times in the past for unhygienic practices in regions with high rates of maternal and child deaths.

Data released by the World Health Organization in February shows that 95% of the 287,000 deaths associated with pregnancy and childbirth in 2020 occurred in poor countries, mostly in sub-Saharan Africa, because of inadequate health facilities or personnel, particularly in remote areas.

Kenya has one of the highest maternal mortality rates in the world, with 530 deaths per 100,000 live births.