Traditionally, these dolls are carried on the back of women either hoping to conceive a child or to ensure the attractiveness of the child being carried. Though carrying an Akuaba on your back to conceive is not as widespread as it was in the past, the practice is still carried out in some part of Ghana today
The name akuaba comes from the Akan legend of a woman named Akua who was barren, but like all Akan women, she desired most of all to bear children. She consulted a priest who instructed her to commission the carving of a small wooden child and to carry the surrogate child on her back as if it were real. Akua cared for the figure as she would a living baby, even giving it gifts of beads and other trinkets. She was laughed at and teased by fellow villagers, who began to call the wooden figure Akuaba, or "Akua's child." Eventually though, Akua conceived a child and gave birth to a beautiful baby girl. Soon thereafter, even her detractors began adopting the same practice to overcome barrenness.