Counties where babies are dying before they take their first breath

In Tana River County, more than one in every three pregnancies ends not with the sound of a newborn's cry, but in silence. The county has the highest stillbirth rate in 

Kenya, at 33.4 per cent, according to the latest Maternal and Perinatal Death Surveillance and Response (MPDSR) report by the Ministry of Health.
West Pokot follows at 27.9 per cent, then Garissa at 24.8 per cent and Lamu at 24.6 per cent. Marsabit records 23.5 per cent, Isiolo 23.4 per cent, Vihiga 22.5 per cent, Trans Nzoia 22.1 per cent, Mombasa 21.8 per cent, and Meru 21.3 per cent. These are the ten counties with the worst stillbirth rates in the country.

Also read: Inside Kenya’s deadliest counties for mothers

At the other end, Nyamira records the lowest stillbirth rate nationally at 8.9 per cent. A baby born in Nyamira is nearly four times less likely to be stillborn than one born in Tana River. Kisii and Turkana both follow at 11.2 per cent, Uasin Gishu at 13.3 per cent, Nyandarua at 14 per cent, Homa Bay at 14.3 per cent, Bungoma at 14.4 per cent, 

Migori and Makueni both at 14.9 per cent, and Narok at 15.2 per cent.

The report, which analysed data submitted by county health departments between 2020 and 2022, also found that the national neonatal mortality rate stands at 21 per 1,000 live births. The leading causes of neonatal death mirror those driving stillbirths: asphyxia and low birth weight.

Of all perinatal deaths reported and reviewed, nearly three-quarters, 74.5 per cent, occurred before or during birth. Only 24.4 per cent occurred during the neonatal period. 

Among those who died before or during delivery, macerated stillbirth accounted for the majority at 54 per cent, with fresh stillbirth at 46 per cent.

Macerated stillbirth means a baby dies at least 12 hours before delivery, often before labour even begins. When a baby dies inside the womb hours or days before birth, it frequently points to warning signs that were missed, inadequate monitoring during pregnancy, or a mother who could not reach a health facility in time.

The highest number of perinatal deaths occurred during the early neonatal period at 1,270, representing 40 per cent of all perinatal deaths. The antepartum period, before labour begins, accounted for 1,021 deaths at 32 per cent, while the intrapartum period, during labour and delivery, accounted for 761 deaths at 24 per cent.

Asphyxia, the deprivation of oxygen at or around the time of birth, is the leading cause of perinatal deaths at 17 per cent, followed by low birth weight at 13 per cent. Sepsis and congenital malformations each account for 11 per cent.

Three delays, one outcome

The report identifies three distinct delays that explain why so many babies die, and why those deaths are concentrated in specific counties.

The first delay happens at home, before a woman even attempts to seek care. The report found that 62 per cent of deaths involve a lack of knowledge about available health services, danger signs during pregnancy, or where and when to seek help. A further 32 per cent involve failure to recognise danger signs altogether, while 6 per cent involve the high cost of health services.

The second delay happens on the way to care. Long distances to health facilities account for 31 per cent of contributing factors. Poor road infrastructure follows at 30 per cent, lack of transport from home to facility at 24 per cent, and lack of proper communication between health facilities at 15 per cent.

Also read: Kenya must make prevention the heart of maternal and newborn care

The third delay is the delay in receiving adequate care after a woman has reached the hospital. Lack of resuscitation equipment accounts for 26.8 per cent of associated factors, lack of infrastructure for 23 per cent, inadequate infection prevention and control measures for 14.3 per cent, and lack of transport between facilities for urgent referrals for 12.3 per cent.

"These deaths are not inevitable"

Dr Issak Bashir, Acting Director of Family Health at the Ministry of Health, says the solutions are known.

"Preventing maternal and perinatal deaths is a collective responsibility. It calls for efforts to create a safe, conducive, and protective environment for pregnant women and their newborns," he says.

Dr Bashir calls for stronger antenatal care, better roads, more ambulances, functional referral systems, and facilities equipped with basic resuscitation tools. In counties such as West Pokot and Tana River, consistent quality antenatal care remains out of reach for too many women.

"These deaths are not inevitable. They are the predictable result of choices, about where to build roads, where to post health workers, where to stock equipment, and whose pregnancies the system treats as worth protecting," Dr Bashir says.