In Kenya, pregnancy-related deaths remain far too high

“Inspiring change” served as the 2014 International Woman’s Day (IWD) theme and for an African woman nothing could be as inspiring as a new study released in Nairobi, Kenya, a week after March 8, the day set aside to mark IWD.

The results of the study brought to light scenarios that have been hidden from public view.

“Pregnancy and childbirth should not terminate a woman’s life,” declares the results of the study, funded by the UK’s Department for International Development and conducted by the International Centre for Research on Women (ICRW), and the CDC-affiliated Kenya Medical Research Institute (KEMRI), Family Care International (FCI), and Public Health Collaboration from 2011 to 2013.

In Kenya however, 15 women die on daily basis, partly as a result of subjection to constant rights abuses despite their shouldering an overwhelming amount of responsibilities within their families — both where they are married and their homes of birth.

Statistics show that for every 100,000 births, 360 mothers die. Beyond the figures, it is only now dawning on policy makers that the death of a woman is a price too high to bear, not only to the families involved but to the national economy as well.

Dr. Frank Odhiambo, branch chief of the Health and Demographic Surveillance System at the KEMRI, says that the death of a woman has a devastating impact on her children. “A mother’s death harms her children’s health, interferes with their education and diminishes their future opportunities in a way that it is just beginning to emerge,” he says.

The study conducted from 2011-2013 in three Kenyan sub-counties in Western Kenya shows a mother's death far too often leads directly to the death of her newborn baby.

Among 59 maternal deaths examined in the study, only 31 infants survived delivery. Of these, however, eight died in their first week of life and another eight died over the next few weeks. Within a year, only 15 babies survived the death of their mothers at child birth.

According to the study, when a mother dies, the high economic costs (medical care, funeral costs and loss of income) that come with a maternal death create a disruption chain that forces many children to withdraw from or miss school because their families can no longer afford to pay school fees. Other children leave because they have to fulfill the roles and responsibilities that their mothers had performed.

In a country filled with cultural norms, where girls are still seen as homemakers who do not deserve to go to school in many communities, Dr. Odhiambo says that even for children who continue their schooling, their grief and new household chores often negatively affect their school achievements and future prospects.

Benson Muok, a widower and farm laborer, paints the picture many husbands face when they lose their spouses.

“I earn two thousand shillings (USD $23) a month as a farm labourer. This is never enough when one of my children is sent home for some of the many school levies — like the Parents and Teachers Association or examination fees. This often forces my children to skip schools as I have to ask around, borrow or seek other supplimentary jobs to raise the needed money. This is minus clothing, food and health needs. Life used to be bearable when my wife was alive as she used to supplement my earnings,” he says.

In many of the African families, where extended families often all eat together, nearly three quarters of the children and other household members in the study had to change the place where they took their meals after the mother’s death. While most surviving children were fed and in many cases taken in by a grandmother or other family or kin member, this dislocation still represents a traumatic breakdown of the family unit.

“A mother’s death is a devastating loss but her death often culminates in the dissolution of the family itself,” adds Dr. Odhiambo.

Michael Rabala, another widower, confesses life has not been easy. “At the time my children needed to be studying and concentrate on their books, they will instead be up and about looking at how they will make something to eat, or go to fetch water in the river. Often home work is left half done because once it reaches 9 or 10 p.m., the child cannot read”.

According to Martha Murdock, VP for Regional Programmes at Family Care International, the health of a mother and her newborn are closely connected: most maternal and newborn deaths are caused by the poor health of the mother ahead of or during pregnancy, or by poor quality care through and immediately after childbirth.

Ways for improving the health and survival of a mother and her baby have to be found.

“Kenya remains among countries in Africa where it is still too dangerous for a woman to get pregnant,” said Christian Turner, British Envoy to Kenya.

Reasons for these are many and varied. But they include poor access to quality obstetrics and neonatal care around the time of delivery.

Over half of the Kenyan women give birth at home without skilled care. Only one in three health facilities give maternity services and one in 10 hospitals offer basic emergency obstetrics care.

A 2006 World Health Report by the PEPFAR, CDC and others noted the severe shortage of health workers across sub-Saharan Africa, including Kenya.

Yet to deliver essential health services, including skilled birth attendance, hypertension, and diabetes, which also affect women the most, Kenya needs a strong nursing workforce.

While the WHO recommends 235 nurses, midwives and doctors per 100,000 people, Kenya currently has 109 health workers per 100,000.

The ministry of health data shows that the public health sector delivers 50% of the health services

Turner says that the world has been behind in recognizing that reductions in the newborn motility have been slow.

The WHO says poor maternal and newborn health is a key contributor to the burden of disease in developing countries: globally, an estimated half a million die during pregnancy and childbirth every year, and an estimated four million babies die in the first four weeks of life. The health of a mother and her newborn are closely linked, with most maternal and newborn deaths caused by the poor health of the mother before or during pregnancy, or by poor quality care during and immediately after childbirth.

Murdock says connecting these interventions through integrated programs can lower costs, promote greater efficiencies, and cut duplication.

Globally the attention on the Millennium Development Goal targets left out survival of newborns. “More must be done to protect newborns”, says Turner.

There is still a long way to go; to reach the targets of MDG4 and 5, Kenya’s infant mortality rate needs to fall to 33 per 1,000 while that of mothers to 100 per 100,000.

The top causes of maternal and child mortalities are ailments such as diarrhoea, malaria, bleeding during pregnancy and unsafe abortions and infection from germs. James Macharia, Cabinet Secretary of Health, Kenya, says that boosting primary healthcare could save thousands of lives every year and make Kenya a friendlier place for women and children.

The UK has supported Kenya government’s efforts to tackle maternal and newborn deaths for many years. DFID has committed UK $171 million (UK Pounds) to increase fair access to affordable quality basic health services; this includes reproductive health, family planning, malaria and broader efforts to strengthen Kenya’s health system.

The UK has already delivered 5.2 million bed nets to pregnant women and children and by next year, more than 340,000 women will have access to modern family planning services.

It is also funding a $75 million (UK Pounds) programme that is to ensure 9,000 health workers acquire life saving skills. By the end, it is expected that the high maternal and neonatal deaths will be reduced considerably.