A woman attending an antenatal clinic.
“It is unacceptable that women should continue to die while giving birth. Protecting the lives of women and children is a responsibility we must uphold without compromise.”
These are the words of President William Ruto. On that, I am totally in agreement with him.
However, if the loss of mothers during childbirth is unacceptable, then why isn’t there a national outrage every time Kenya loses approximately 6,000 women annually?
Mr President, allow me to put these 6,000 annual deaths every year into perspective. They translate to 16 or 17 deaths every day. That is one mother dying every hour and a half. By the time this article is published, another Kenyan woman will have died while giving birth. Picture a plane full of 180 passengers crashing every 11 days. In a year, it’s 33 fully loaded jets crashing out of the sky.
The normal reaction would elicit an emergency parliamentary meeting. There would be commissions and resignations. Nobody would call it fate.
But women are dying silently… in theatres without blood, where there’s no one to operate, in “health facilities” without staff, in ambulances without supplies and some at home because they cannot afford transport to healthcare facilities. Where is the uproar?
Forty per cent of maternal deaths are caused by postpartum haemorrhage. Twenty-eight per cent are caused by obstructed labour. Fourteen per cent occur from eclampsia. They are preventable and treatable conditions if health systems work like they should.
We have known for decades that access to timely skilled care, blood transfusion, emergency surgery, and essential medicines can drastically cut deaths from childbirth. Having a referral system that works so women can be transferred when complications occur. Stocking essential medicines like oxytocin to stop bleeding and magnesium sulphate to treat eclampsia. Ensuring women deliver with a trained midwife by their side. These are the basics of maternal healthcare, yet, they remain elusive to many women.
While science has clearly identified the medical causes of maternal death, we must also confront the cost of corruption to maternal healthcare. Recent reports of approximately Sh10 billion being lost through unverified claims under the Social Health Authority raise more than financial concerns. That money could establish about 30 fully equipped maternal high dependency units in referral hospitals across the country; 30 facilities where a woman in shock from severe bleeding is monitored, transfused, stabilised, and saved within minutes instead of deteriorating on a general ward as well as 30 centres of advanced emergency obstetric care across counties where complications are currently fatal.
It could equip blood banks in all 47 counties with enough funds to guarantee consistent storage, screening and delivery of safe blood products. Sh10 billion could also buy more than 200 fully equipped ambulances strategically located at sub county level to improve referral systems countrywide. Women won’t lose their babies to obstructed labour because the nearest ambulance was too far away. It could also cover salaries to recruit and retain an estimated 700 to 800 midwives for a period of two years to boost coverage of skilled birth attendance in areas where there are none. Having a skilled birth attendant present at your delivery is still the single greatest predictor of maternal survival.
It could guarantee uninterrupted supplies of essential medicines such as oxytocin for bleeding and magnesium sulphate for eclampsia across public facilities for at least two years, eliminating the fatal phrase “out of stock.” It could support hundreds of thousands of transport vouchers for low income mothers, because free maternity services are meaningless if a woman cannot afford to reach the hospital.
Linda Mama demonstrated that when financial barriers are deliberately removed, maternal health outcomes respond. Designed to tackle the financial barriers to skilled maternal care, the programme first removed user fees for services in public facilities and subsequently was expanded to also cover faith based and private providers, relieving pressure on strained public hospitals. Evaluation revealed an increase in accountability and expanded coverage of benefits. The 2016 revision improved accountability by transitioning administration to the National Hospital Insurance Fund and clarified that the benefits package included antenatal and postnatal care. Linda Mama demonstrated that financing reform can and does shift women towards facilities and skilled care when it is well-designed and scaled up.
If there was sufficient political goodwill, maternal mortality would drastically reduce from 355/100,000 live births. Family planning would be integrated into maternal care, eliminating unplanned pregnancies and closely spaced pregnancies that leave mothers vulnerable. Skilled care during childbirth would be available in every county, not just concentrated in urban hospitals with deliberate investments to overcome shortages through sustainable financing and strategic human resource planning.
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Dr Bosire is a medical doctor and lawyer. [email protected]
