The demographic characteristics of healthcare providers are provided in Table 1.

Table 1 Characteristics of healthcare providers who participated in the study (n = 20)

The demographic characteristics of women who participated in the study are described in Table 2.

Table 2 Characteristics of women who participated in the studyThe hospital context

At 6:30 a.m. on a Monday, the cleaner, Alhassan, was already at work, mopping the long corridors that opened into the patient wards. His mop bucket was half-filled with a lathered solution - water mixed with soap, chlorine and disinfectant - that left a fragrance on the corridors. He mopped from the main entrance right through to the end of the ward, and adjacent corridor. Even while he cleaned, a few visitors tried to walk past him to see their relatives. He complained that they would dirty the floors, and then the doctors and nurses would think he had not worked.

While he was mopping, the matron-in-charge arrived on the ward, quickly noticed and commended the good work he was doing. This energized him. When he mentioned to the matron that the visitors were ‘disturbing’ him, she immediately ordered the security man to shut the doors and restrict further entry by visitors.

Once the matron sat down at the nurses’ desk and settled in, a few nurses gathered around her- including those from the night shift and those who had arrived from home for the morning shift. The team then went through the routines of ‘handing over’ and ‘taking up’, with the night staff giving an account of the night shift, admissions and discharges, and moving around from bed to bed to show whose condition was stable or unstable and who needed further care. Once this was done, the matron-in-charge instructed the junior nurses to straighten up the patients’ beds and check their vitals, while a senior nurse supervised the setting up of the Rounds Trolley and equipment in preparation for the doctors’ arrival for the ward rounds.

This scene above is one of many observations of a typical morning in the maternity wards. Various actors coordinate to facilitate the provision of care for women in the maternity wards.

Both hospitals have a medical director who is the head of the hospital management team. The core hospital management team comprises the clinical coordinator, administrator, accountant, pharmacist, and director of nursing services. The roles of the management team include planning, organizing, coordinating, budgeting, innovation, representing the organization, etc. The management teams have regular meetings to discuss administrative and clinical issues and make relevant decisions on service delivery and the running of the hospital.

The maternity wards have a ward manager (senior nurse) or ‘matron-in-charge’, who oversees the day-to-day administration of the ward and is directly responsible for supervising nurses and auxiliary staff in the wards. There is also an overall head of the unit who is a Specialist Obstetrician and who supervises other medical doctors on the unit. Medical and nursing students are often found on the wards for short rotations or internships. Healthcare assistants (with some basic training in nursing care) and “orderlies” (cleaners) perform various roles on the wards. Within this context, we identified several facilitators and barriers to healthcare delivery and IPC compliance.

Facilitators and barriers of IPC

We identified four themes denoting IPC facilitators: Leadership commitment and support, Perception of IPC as a form of professional care for patients, Training and education for IPC, and IPC as a form of Self-care. Five thematic areas represent IPC barriers, comprising, the ‘invisibility’ of HAIs, low prioritization of IPC by managers, Lack of resources and sufficient goals for IPC, discretionary use of protocols, and communication-related challenges.

Facilitators of IPC complianceLeadership commitment and support towards infection prevention and control

When asked about IPC policies and implementation, hospital managers emphasized their commitment to improving IPC on the wards. A manager said:

Well, infection prevention is a priority, and we see it as an obligation, so we provide the necessary funds. Because if you don’t, it’s either the patients are being infected or the staff are being infected, and either way, this is increased cost. So why not do the prevention rather than the cure? … apart from the inconvenience, it causes more morbidity to the patient, and the length of hospital stay is increased and all that… also, it affects the image of the hospital in terms of quality care. (IDI-1 M, Manager)

Apart from the management team, there were other operational teams in the hospitals to whom various tasks were assigned. Some actions by management were identified to be supportive of IPC. These included the formation of IPC committees in TH and Quality Assurance committees in SH to identify gaps in IPC and provide support to improve IPC and the delivery of quality care. In TH, IPC focal persons, also known as IPC champions, were appointed among the healthcare providers as local ambassadors for IPC. Part of their responsibility was to drive the implementation of IPC protocols on the wards. In SH, the Quality Assurance team is responsible for overseeing quality care delivery including IPC policy implementation in the hospital. This team was headed by a Senior nurse who is also in charge of IPC. She mentioned that she was responsible for coordinating IPC activities and conceptualizing innovative ways to improve IPC on the wards.

During observations and interactions with the various clinical teams, doctors and nurses discussed the shared value of safe practice and quality care and emphasized the importance of teamwork. Doctors are in charge of leading ward rounds, and other health providers participate in the ward rounds. Patient conditions and management plans are discussed during the rounds. Doctors delegate tasks to other team members based on the workload and team dynamics, and as they deem appropriate.

Nurses were careful to dedicate time during their shifts to ‘handing over’ and ‘taking up’.

A Matron-in-charge narrated:

I have to schedule the work for everyone to work. We have six suites, so I put one midwife in each suite, and if there are rotation midwives or nurses, I add them up…then I send someone to the theatre to receive the babies there. Then … we have to do admissions and discharges as well. …If there is any difficult delivery, then I have to be called … sometimes I have to call on a doctor to come and intervene. (IDI-3 F, Midwife).

Nursing staff took care of ward logistics and administrative issues such as documentation of admission or discharge of patients and attending meetings. Documentation was done by the nurse-in-charge at the beginning and end of every shift, to show work done during the shift, and patient numbers and conditions. One of the nurses disclosed that doing this right signifies the power or authority of the matron-in-charge and reflects responsibility toward her role.

A midwife stated:

OK, when we come in the morning… you take up from the previous shift. After taking up, you go through the ward to give medications. Then, maybe, we share our roles in the various suites … (IDI-1 F, Midwife).

Another nurse stated the following:

… after taking up, we pack our delivery instruments for sterilization… then we go to the laundry for bedsheets, delivery towels, and theatre gowns. Then, after that, if anyone is in labour, you monitor them. (IDI-2 F, Midwife).

The management of patient conditions was regarded as essential by healthcare providers. Core clinical tasks are more closely associated with expertise and therefore more gratifying as expressed by IDI-3 F (midwife), who proudly described how her colleagues draw on her expertise or that of the doctors “if there is any difficult delivery”.

Administrative tasks were often associated with status. In SH, a manager explained the various administrative tasks he must perform due to his status as a director. When asked to give the highlights of a typical workday, he responded:

On Mondays, we will have an Obs and Gynae Quality Assurance meeting from 7:30 am to 9:30 am, then a management meeting up to about 11:30. … Then I go around… just to look at various places in the hospital and how things are going. Tuesday is a typical clinical workday for me, so ward rounds from 7:30 am to about 10:30, then I go to the outpatient clinic, which will take almost the rest of the day… Wednesday is an Obs day, I may have a few surgeries… after that, I’ll come and do office work… Thursday is basically administrative stuff, so again, I work in the office; after office work, I go around. Then Friday is basically a theatre day for me… So, from the theatre, I’ll come back to the office. On the weekend if I’m on duty… I take it up. In terms of administrative work, I sit at the office and do some administrative work… signing stuff, and after that, meetings. So, I schedule most of the administrative meetings for Wednesday or Thursday when I do little clinical work.

Time was also dedicated to meetings involving senior staff who have the responsibility for decision-making on the wards. Due to the authority and power held by managers in these roles, their administrative roles are respected, and their instructions are taken seriously by other staff. However, the long hours spent at these meetings and on documentation take time away from rendering care or supervising care delivery. Moreover, the focus of these meetings and documentation is mainly biomedical, and IPC may be evaded.

Healthcare providers’ responsibility to render professional care to patients

Resident doctors, medical officers, and interns stayed behind to manage the wards after the morning ward rounds. They reviewed patients’ folders, performed any tasks assigned by the consultants during ward rounds and took care of any new admissions and emergencies arising. Healthcare providers dedicated efforts to clinical care as there are potentially great repercussions if a healthcare provider slacks or makes mistakes. On ward rounds, senior doctors sternly reprimanded other staff when clinical protocols were not followed, or medications were missed or omitted. A nurse spoke about the need to minimize the spread of infections from shared medical devices, by cleaning them well after they have been used on any patient. We observed efforts to clean thermometers with ‘methylated spirit’ after every use.

Clinical emergencies were attended to promptly. It was indicated that sometimes a doctor could be called while conducting ward rounds to attend an emergency in the theatre. A few health providers described the different ways in which they react when handling emergencies. A midwife mentioned how the use of PPEs may sometimes be compromised when handling such cases.

Normally, we wear two gloves when delivering. You use the first one to conduct the delivery then you change it. But sometimes there could be an emergency case after you have already delivered the baby… If the baby is not crying, you have to resuscitate the baby. At times, you even forget to remove the first glove (IDI-2 F, Midwife).

Two midwives indicated that they would go ahead and receive an emergency birth even if they were not adequately gowned or gloved, as it involved saving a newborn or a mother’s life.

A healthcare assistant described scenarios where she exercised fewer precautions, or precautions were not taken even when it was indicated, for example, when a patient was an acquaintance.

For patients with whom staff were acquainted e.g., other staff members or influential people, a manager described that “we sometimes go the extra mile for them”, but quickly added: “There is only so much you can go above your regular standards or levels of care”. In making a case to advocate for managerial and political commitment to improve the infrastructure and equipment within the hospital, he added: “Get people in power to use the facilities. If it doesn’t touch their skin, they don’t feel it much”.

Orderlies like Alhassan described the importance of their work in ensuring that the ward was clean so that healthcare providers could do their work without any distractions. Orderlies were assigned some other tasks, such as laundry and disinfection of equipment, from time to time.

Education and training for IPC

Management members informed us during the interviews that newly employed staff are taken through an orientation process during which IPC training is also done. In TH however, a midwife who had been working on the ward for over two years informed us that she had not received any IPC training. Apart from that, other staff, including the orderlies in both hospitals informed us that they had received IPC training within the past year. There was however no available structure for refresher trainings for staff.

On the maternity wards in both hospitals, there were posters of clinical protocols, guidelines for emergencies, and pictures portraying the importance of hand hygiene, demonstrating hand washing with soap and water, or how to use the alcohol hand rub (also called sanitizer), etc.

Discussions on IPC were sometimes a part of the agenda at monthly unit meetings, where issues related to patient care were discussed and shared to improve the quality of care.

Some nurses described how they implemented knowledge acquired from IPC training and workshops. For example, a nurse described efforts at waste segregation and the use of safety boxes on the wards:

Like our safety box here, we have one in every suite, and we discard the needles appropriately. In addition, we also separate our waste bins. We have bins for infectious waste and general waste. (IDI-2 F, Midwife).

From our observations, however, waste was often not segregated as described. Whereas health providers talked about the use of color-coded bins, a lack of compliance with color codes was observed by the research team several times on the wards. Some health providers explained that the resources including colored bin liners were sometimes not available for use.

Patient education and counseling were perceived to improve attitudes toward hygiene practices. A midwife informed us that patient engagement is best done at the Antenatal Care (ANC) clinics where women receive most of their education during pregnancy. We found that these avenues also enabled healthcare providers to interact with mothers and provide health information. Some of the women we interviewed had been referred from other hospitals for further treatment at TH or SH. Although they attended ANC clinics at other facilities, there were similarities in the information they received at the various hospitals. A mother stated:

I learned about nutrition and how to protect myself from illnesses. When you’re pregnant, there are a lot of factors to consider so you have to watch what you eat (AC1).

Some of the women shared what they could recall from the health talks with nurses during their hospital visits. When asked what they understood by the term puerperal infection, women gave varied explanations such as: “extensive bleeding after birth.” (AC 4), “a sickness you get when you deliver or when you are operated on…” (AC 7). Other women went ahead to describe symptoms such as weakness and chills, increased temperature, bleeding, headaches, and loss of appetite. A participant shared an experience where she felt her wound was exposed to water, causing an infection. She described that “the wound started smelling, and some water too started coming out from there”.

Due to the approach of sharing information to large groups of women at a time, it appeared there was little opportunity for women to engage actively and seek clarity on the information shared during the educational talks. In addition to the health education by HPs, some women described obtaining information from their peers, family members and community members.

IPC as a form of self-care for both health providers and women

In describing her motivation for performing hand hygiene, a nurse in TH said:

You have to think about yourself… because if you think about your own health, anything you do, you have to wash your hands (IDI-4 F, Nurse).

Where patients were perceived to be neglecting self-care, some HPs discussed the risks of infection if relevant steps were not taken. During the interviews, a nurse explained that some women sometimes had to be prompted to practice personal hygiene on the ward:

Sometimes, some of them don’t take their bath because they have been operated upon… one time a colleague of mine had to pull one all the way to the washroom… to take her bath, because she started becoming offensive.

A nurse narrated:

I think that for some of them, when they are in labor, they don’t even take their bath until they come here, so their skin is dirty. To set IV (intravenous) lines on them, we do alcohol swabbing, but sometimes you are in a hurry, and you wouldn’t do it very well before you push the needle in. So, I think that one too, infection can occur. (IDI-1 F, Midwife).

Another nurse added that when setting IV lines,

You have to wear gloves and clean the skin surface so that you are assured that you and the patient are protected. (IDI-5 F, Midwife).

A nurse explained that whereas she and her other colleague nurses would usually put on gloves to discard the body fluids of patients, they sometimes observed some women asking their relatives to go and discard their urine for them ‘without gloves’. She also mentioned that some women preferred to be cleaned and cared for by their relatives rather than the nurses. She then expressed concern about relatives, who remain in the hospital to attend to the needs of women after childbirth, and their risk of exposure to infections, saying: “They are even exposed more than the patients” (IDI-6 F, Nurse).

Some healthcare providers mentioned that they felt vulnerable to acquiring HAIs from patients and mentioned that some of their colleagues had previously acquired infections because of providing care to patients. A nurse indicated that exposure to blood and body fluids during the clamping and cutting of the baby’s cord after delivery exposes one to a risk of infection. Some healthcare providers feared that they might be exposed to infection by touching patients during a clinical examination. A nurse narrated:

Sometimes after delivery, if the client has a tear, you have to suture… and maybe the person has STDS, and you can get it through blood contact.

When you are checking contractions, you have to put your hands on the person and monitor for 10 mins before removing your hands. And also, body fluids… So, if the person has Hepatitis B, you are exposed to that (IDI-6 F, Nurse).

Some women also described some steps taken for self-care to prevent contracting infections. One woman said:

If I am going to use the washroom, I go with my Dettol and everything, to ensure I don’t go and pick up any diseases… When I am done, I wash my hands with soap and water neatly (AC 12).

During the FGDs, women explained that keeping wounds clean and changing wound dressings daily was important. More than half of the women believed that it was important to bathe once or twice daily after childbirth.

Barriers to IPC compliance

IPC barriers comprised the ‘invisibility’ of HAIs, lack of prioritization of IPC by hospital leaders, lack of goals and sufficient activities for IPC care, discretionary use of protocols, and communication-related challenges.

The ‘invisibility’ of HAIs, and variable perceptions about HAIs and HAI risks

When asked about HAIs, most healthcare providers did not have any experiences or encounters to share. They indicated that there were no available documents on HAI on their units that could be referenced. Two healthcare providers said they had ‘no experience’ with HAIs on the wards. A midwife said:

For here, I have not seen any, because here, they don’t keep long here … the maximum they can spend here is maybe 20 hours … because after delivery, after 6–8 hours, they have to move into the ‘lying-in’ ward. (IDI-3 F, Midwife, SH).

Another nurse referred to “the usual ones, usually the cold and stuff. The typical ones like getting pricks”. She added “Some do get pricks; I have been a victim before” (IDI-7 F, Midwife).

About a third of the health providers interviewed mentioned concerns about needle pricks:

… but there was one orderly who had a needle prick and was put on medication. That was just some months ago (IDI-3 F, Midwife, SH).

A nurse explained the possible risks of getting a needle prick if one does not take precautions when setting IV lines and said, “… the patients also have the risk of getting the infection and you have the risk of getting the prick”.

Women in the FGDs perceived themselves to be at risk of infections when healthcare providers attend to them without observing hygiene protocols. A woman said:

If they don’t take the right precaution, such as wearing gloves when putting their hands in your vagina, it can give you infection (AC 10).

Several of the women associated infections with unclean washrooms, unclean beds, lack of hand hygiene among healthcare providers, and lack of personal hygiene among mothers. During the FGDs, two of the women mentioned that puerperal infections may have underlying spiritual causes. A woman mentioned that walking around barefoot can cause an infection.

Low prioritization of IPC-related tasks

In TH, the IPC coordinator indicated that his concerns about IPC are only channeled through to the management level by his supervisor if his immediate superior is interested enough in the ideas to communicate them to the next level where management has the authority to act on them. He also mentioned that he did not feel adequately supported to perform his role, for example, his immediate supervisor did not give him the required scheduled time off clinical work to perform IPC monitoring.

From observations, prioritization of tasks was driven by how much attention was given to the task by the more senior health providers, including the Matron- in-charge. Senior nurses delegated some nursing procedures, such as wound dressing, and activities, such as cleaning, to junior nurses, students, or healthcare assistants. Likewise, senior doctors delegated tasks to junior ranks during ward rounds. Delegation of tasks meant staff also decided what would be prioritized, what would be done urgently, and what would be passed on or left for later.

Some tasks were delegated to health assistants or students. These student nurses were expected to know the rationale behind these tasks and have the competency to carry out these tasks or ask for help if needed. However, observations revealed that this was not always the case. Junior nurses commonly described how they had to learn and find things out by themselves. A nurse shared an experience from her early days on the ward:

… nobody oriented us, we just came to the ward and started working. So sometimes I get very confused when they say ‘go here and get me this’. I am learning and finding out things around here by myself.

Aside IPC-related tasks, some procedures are delegated to health assistants or students. This may be associated with complications and infection risks.

A mother narrated:

… after I finished delivering, they had to remove the ‘dirty blood’ or blood clot (placenta); a student showed up and asked Auntie M (midwife) to teach her how to remove it. So, she left it for her, and while removing it, she didn’t remove it all… and some was retained. I kept bleeding heavily afterward. At first, I thought it was because of the delivery. Even after transfusing me, I was still bleeding. And they went to examine me and found that there were retained clots.

Lack of resources and sufficient goals for IPC

Health providers in both hospitals expressed the need for more equipment and resources to enable them to do their work more effectively. A doctor mentioned that opportunities to practice IPC were affected by resource limitations:

… for two days, there has been a water issue, but even then, they got water in the barrels so that we could still wash our hands. (MD1)

Another nurse reiterated that the wards rely on water fetched into barrels for handwashing when the tap ceases flowing unpredictably. Speaking of logistic challenges, a manager said:

For example, if you take spirit gel, it’s a little expensive on the market, so we’ve been trying to get our pharmacy to produce it. They did, but we ran into some problems with some machines, which we are trying to solve, so maybe in the next month or two we should be able to get over that.

A few times too, we may run out of a particular color code of lining (for the waste bins). Aside that, we’ve not had too many challenges. It’s all about how well you want to be committed to it.

The aesthetic value of cleaning was emphasized by both healthcare providers and orderlies. Otherwise, no clear goals for IPC were mentioned by participants during the interviews. Orderlies like Alhassan often focused on sensory cues and explained that it was important for the ward to also smell nice. To achieve this, Alhassan described the meticulous process of sprinkling extra bleach on the floor and leaving it for a period to remove any unpleasant smell, then carefully adding nice-smelling detergent to a bucket of water used for mopping the corridors.

However, some HPs mentioned that a clean-looking floor does not necessarily mean there are no germs, as germs cannot be seen with the naked eye. Nevertheless, they agreed that it was important to keep the floors clean and keep the ward smelling nice.

A nurse said:

The place is cleaned but not to the extent that you can’t get an infection. The place has been cleaned in such a way that you can use it, but you must still protect yourself.

Another midwife added:

They can use dirty water and clean the place. You might think the place is clean, but actually, the water used may be infected by other organisms… but physically you see it to be clean… but not necessarily free from organisms. In our system, we use detergents and disinfectants together so that as we are tackling the infections, we are also tackling the dirt as well.

Orderlies also sometimes used their discretion to decide which duties were “part of their job”, as there seemed to be no clear job description, and no clear set of activities for them to perform. HPs sometimes complained that some orderlies also ‘disappeared’ from the wards after early morning cleaning to attend to their personal business. This also happened when the orderlies were sent on casual errands by HPs.

During observations, our attention was drawn to empty alcohol hand-rub dispensers in the unit. It was suggested that a nurse refill these dispensers daily. However, it became evident that the orderlies were expected to refill the dispensers and fill in the gaps for tasks to which no one had been assigned. This was not effective without supervision.

Discretionary use of guidelines

According to some heealthcare providers, their hygiene practices were sometimes influenced by what they could see or smell, or what was subject to be inspected or noticed. In preparation for ward rounds, nurses ensured that the ward and working spaces were looking clean and smelling good. Although this was done on most mornings, extra attention was given to this process on the mornings of major ward rounds. They considered this as important, as the matrons could also come round for inspection in preparation for major ward rounds, which were held on specific days, once or twice a week. Nurses felt that preparing ahead for these tasks allowed them to be better positioned to be of service and respond to requests from their supervisors.

We engaged some of the health providers in discussions about the use of protocols and IPC guidelines in their line of work. Some of them indicated that they did not often prioritize the use of guidelines. A midwife said:

Sometimes I read … and you know… because of the busy schedule of the ward, sometimes when you come, you have to take up so that the previous people can go home and go and rest. However, sometimes when I am free, sometimes I take them and read (IDI-1 F, Midwife).

A matron-in-charge, when asked about the antibiotic policy of the hospital, answered:

It is something that is taught in school; it’s not like the hospital should get a policy for you… For any medication, you have to know the patient you are giving it to, whether the drug is expired, and the strength you are giving. Everything is being taught already; it is part of your midwifery or your nursing training. You don’t have to get a hospital policy before you follow that. (IDI-3 F, Midwife).

Another midwife answered:

Antibiotic policy? If there is one, I wouldn’t know. We don’t normally prescribe because we have doctors around.

Speaking about IPC compliance during procedures, a nurse at TH said:

You know… if we are dressing the cord for babies… like 20 babies... I don’t think you expect me to wash my hands after each cord dressing.

A doctor explained that he was not aware of any protocols guiding the insertion or removal of intravenous (IV) lines, but added:

…from what we have learnt, we know that cannulas and catheters should not be left in there for a long time… it could be a source or focus of infection, so it is best to change it after some time.

During interviews and observations, an orderly in TH described a way of cleaning, where ‘high-risk’ spaces are segregated from ‘low-risk’ spaces. He explained that he would, for example, clean the matron’s office with a different mop from what would be used to clean the patients’ bathroom. He indicated that this was his interpretation of what was described in the National IPC policy document, as was explained at the last training session he attended.

A midwife raised concerns expressed about how mops were handled, without following any protocols:

My concern is the mop. The orderlies… they put on gloves and then they use the mop. Maybe they have already touched something infectious with the gloves. Somebody else may touch the mop without gloves and get infected. So, for me, I don’t touch the mop.

We also observed mops being left to dry in open or closed spaces, and even around or in drainage pipes.

In TH, staff would strictly use designated washrooms, which were locked and the key only accessible to staff. They would typically not visit the patients’ washrooms. A midwife in TH described the patients’ washroom as “always dirty”, and associated it with a high risk of infection. She mentioned that she advises the women on admission to take along their disinfectants whenever they use the toilets.

In contrast, the washrooms at SH were maintained well. Describing the patients’ washroom, an HP in SH said:

I won’t say very clean… but it’s clean, because there are different people who come here with different attitudes … Yes, because somebody will go, clean the place or use the place in a nice way but the other person will go and mess up the place for everybody else.

During observations in SH, the bathroom and washroom area often had a clean look. The matron-in-charge attributed it to regular cleaning by the cleaning company to which the cleaning work had been outsourced. This was further supported by a senior manager who said:

Our orderlies were doing fine but then if you look in terms of supervision it became dicey. Is it nurses supervising? Is it administrators? Is it an environmental officer? … if nurses come and they’re concentrating on their work, they wouldn’t go to washrooms to check if they’re clean or not. And the washroom is a very important place for patients. So initially we outsourced the cleaning of the washrooms … and the result was okay. It was good.

Communication and information sharing about IPC

Some of the women interviewed reported that health providers failed to communicate with them about their health issues and how to take care of themselves after caesarean sections. A participant shared her experience of how health providers failed to give her information on how to treat her wound after surgery, resulting in wound infection. She narrated that she was disturbed when she was told about the “infection in the wound” and added that the health providers did not tell her the cause of the infection. The woman further explained that although she was worried, she could not gather the courage to make further inquiries about the cause of the infection.

Several women discussed the support of their partners and other relatives, such as mothers, in-laws and grandmothers, in their care. During the FGDs, some women mentioned that they were advised to use alternative or herbal treatments rather than what had been prescribed by health providers.

About half of the women mentioned that they use steam from hot water to help them recover after childbirth: One said:

I sit on hot water, and if there are any herbal medications, I drink them (AC5).

Another woman also mentioned “Dawadawa” (Parkia biglobosa- dried seeds of the African locust bean) as an example of a herb that “helps heal birth injuries”. Two women mentioned that they previously boiled and consumed a local herb called “Bagaruwa” (Acacia seeds) to help heal the womb after childbirth.