NAIROBI (Thomson Reuters Foundation) – Kenya’s dire maternal death rate may finally fall thanks to the introduction last month of free maternity services for women, with some hospitals reporting a 50 percent increase in deliveries.
But experts say more needs to be done to tackle backstreet abortions, improve access to contraceptives and educate women to further reduce deaths.
Kenya’s maternal mortality rate rose to 488 per 100,000 live births from 414 between 2003 and 2008/9. The country will not meet the Millennium Development Goal of a 75 percent drop in deaths between 1990 and 2015.
The number of women giving birth in government health facilities has risen significantly since it introduced free maternity services on June 1.
“It’s around a 10 percent [increase in deliveries] around the country,” Shahnaz Sharif, the government’s director of public health and sanitation, told Thomson Reuters Foundation. “In some places it’s high. Busia County was a 50 percent increase.”
Giving birth with the help of a trained professional is critical for reducing maternal mortality, defined as the death of a woman while pregnant or within 42 days of termination from a cause related to the pregnancy.
But 56 percent of Kenyan women give birth at home.
The main reasons women gave for not delivering in a health facility were that services were too far away or there was no transport (42 percent), that it was unnecessary (21 percent), that their labour was too quick to have time to get there (18 percent) and that services were too expensive (17 percent).
JOY AND FEAR
In Nairobi’s Pumwani maternity hospital – the largest facility in the country – there was joy among mothers when the free maternity services were announced.
“A lot of women named their children after the president and the first lady,” said Wambui Waithaka, a doctor working there.
The staff had been anxious over the implementation of the new policy, a key campaign pledge by President Uhuru Kenyatta ahead of Kenya’s March elections. But it has been well managed so far, Waithaka said.
“They didn’t just hand us free maternity and walk away. They have actually followed up,” she said.
The government is giving the hospital extra money each week to buy the things they need to treat patients.
“We have not run out of gloves. We have not run out of medicines. Those were our fears,” said Waithaka.
Extra doctors and nurses have also been sent to the hospital to deal with the influx.
However, facilities across the country are stretched. In Pumwani, there is a shortage of incubators.
“The babies are all crammed into the incubators,” said Waithaka. “It’s one thing to get the woman into the hospital but you have to make sure what is going on in the hospital is quality, that what’s going on in the hospital is safe.”
The next step is to change women’s behaviour so that they seek out professional help when giving birth, experts say.
“The most critical thing in improving maternal health is educating the woman herself and the community around her,” said Waithaka. “You can build a tarmac road, make the maternity free but if she doesn’t know that her labour is going a dangerous way, we are not going anywhere.”
Almost 28 percent of women give birth at home with the assistance of traditional birth attendants, the same percentage as are helped by a nurse or midwife.
“There are some women, no matter how cheap or how free you make maternal health, [who] want to give birth with the traditional birth attendant,” said Waithaka.
The region where the use of traditional birth attendants is highest – at 64 percent – is Kenya’s arid northeast, a remote, sparsely populated area largely inhabited by nomads. It also has the highest maternal mortality rate, twice the national average.
“It’s tragic for a woman, just because she happens to be in northern Kenya, she dies just because the nearest facility is 200 km away,” said Sharif.
One government strategy is to introduce maternal shelters in remote towns like Garissa, where women can wait to go into labour just metres away from hospital.
More attention needs to be paid to reproductive rights, particularly young women’s knowledge of contraceptives and access to safe abortions.
In Kenya, 43 percent of pregnancies are unwanted due to limited access to contraceptives, poverty and high rates of sexual violence.
Unsafe abortions account for 35 percent of maternal deaths in Kenya, far higher than the global average of 13 percent. At least 2,600 Kenyan women die in public hospitals each year after having botched abortions.
The enforcement of Kenya’s abortion law is not consistent. Rich women easily access safe abortion in private facilities. But the poor and uneducated risk their lives using backstreet doctors as government hospitals are reluctant to treat them.
In Nyanza in western Kenya, 80 percent of maternal deaths are among adolescents, Sharif said.
“They tend to hide their pregnancies. They don’t come to the clinic,” he said. “Or they’ll go for [an] abortion.”
Teenagers also tend to have more complications, he said, because their bodies and minds are not ready to give birth.