In the quest to create global maternal health care protocols, African Indigenous birthing epistemologies are often overlooked in research, policy, and advocacy aiming to improve maternal health and reduce the maternal mortality ratio (MMR). The global maternal health strategy, the Safe Motherhood Initiative (SMI), excludes Indigenous birthing knowledge by requiring all childbirth to be attended by only birth attendants trained in the Western medical paradigm. This forms the bedrock of the assumed authoritative expertise of the Western medical birthing approach. Despite the campaign for sole reliance on SMI, Africa’s MMR remains the highest compared to other regions. Nigeria, Africa’s most populous country, also has the third-highest MMR in the world as of 2020. This failure of SMI to reduce MMR for Nigeria and Africa more broadly calls for the inclusion of marginalized Indigenous birthing knowledge for its epistemological and practical significance. Using Nigeria as a case study, with a transnational connection with the United States, the article argues that excluding African birthing knowledge and methods in SMI promotes epistemic and obstetric violence. Adopting the reproductive justice framework as a decolonial tool, the article asserts that African Indigenous birthing knowledge is simultaneously valid and valuable for holistic approaches to maternal health.

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