Ending preventable maternal deaths should be everyone’s call

Kenya has six years to perform a mighty miracle; six years to turn around the onslaught that women face daily for wanting to deliver on their sacred mandate of bringing forth our next generation.

In Africa and the world at large, motherhood remains a celebrated community event. Despite our fertility rate steadily decreasing over the past three decades, millions of women still go through pregnancy and childbirth every year, consciously or unconsciously taking the bold step to take a chance on life itself.

In six years, Kenya needs to have met its obligations to sustainable development goal 3.1, to reduce maternal mortality rate to less than 70 women per 100,000 live births. Our estimated maternal rates are still unacceptably high, at above 350 per 100,000 live births. What are the odds we can actually do this? In 2015, the World Health Organization (WHO) together with the United Nations Population Fund (UNFPA) set out a global multi-partner initiative, “Strategies for Ending Preventable Maternal Mortality (EPMM)”. This is in recognition that while many countries have made significant advancements in reducing maternal morbidity and mortality, there still exists significant disparities in equitable coverage of essential maternal and perinatal health interventions in many settings.

To this end, EPMM is aimed at improving maternal health and well-being, targeting the achievement of SDG 3.1, while remaining grounded in a holistic, human rights-based approach to sexual, reproductive, maternal and newborn health. The strategy employed is through health system strengthening, by implementation effective universal health coverage. For each country, the adoption of this strategy must be context specific, systems-oriented and people-centric, while prioritising equity.

In the EPMM strategies, the guiding principles include empowering women, girls, and communities; integrating maternal and newborn health; creating supportive legal, regulatory and financial frameworks; and applying a human-rights framework for high-quality reproductive, maternal and newborn health care that is available, accessible and acceptable to all who need it.

In Kenya, we have integrated maternal and newborn health for decades, we have had free maternity care for the past 11 years but we are still struggling with the elephant in the room, the quality of healthcare, and ensuring true access to acceptable care.

The cross-cutting actions described in the strategies include improving metrics, measurement systems and data quality to ensure that all maternal and newborn deaths are counted; and that there is allocation of adequate resources and effective health care financing to assure effective care provision.

With improved access to care through the free maternity care in Kenya, we now have better visibility of maternal and newborn deaths at hospital level; which give a more accurate picture of the true numbers. However, a proportion of mothers and newborns may still die in the community and remain incompletely accounted for in terms of cause of death.

The initiative defines the five key strategic objectives for ending preventable maternal deaths. These include addressing inequities in access to and quality of sexual, reproductive, maternal and newborn healthcare; ensuring universal health coverage for comprehensive sexual, reproductive, maternal and newborn healthcare; addressing all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities; strengthening health systems to respond to the needs and priorities of women and girls; and finally ensuring accountability in order to improve quality of care and equity.

This is where the elephant in the room lies. We may have had free maternity care for over a decade, but the reason it has not impacted our maternal mortality is specifically because it has not quite met the spirit of these objectives. The care provided has not always met the key standard of quality! This compromises access because being able to physically access healthcare is not a guarantee that the care is of good quality, and neither is it structured to accommodate all causes of maternal mortality, most especially when it comes to access to contraceptives and curbing unsafe abortion. The free maternity programme is not sufficiently and equitably financed to address complications that arise out of child-bearing, that require expensive interventions such as critical care, dialysis and other specialised expertise needed. This results in referrals to the higher level public health facilities for access to these specialised services. This leaves these facilities groaning in debt, threatening their sustainability.

The EPMM targets to measure progress include women having at least four antenatal care visits, that all births are attended to by skilled health personnel, that there is initiation of early routine postnatal care, that at least 60 per cent of the population is covered by Emergency Obstetric Care health facilities within two hours of travel time and that lastly, at least 65 per cent of women aged 15-49 do make their own informed and empowered decisions regarding sexual relations, contraceptive use and reproductive health care.

At country level, we must evaluate our milestones, looking at existing policies and plans to ensure they answer to the need; elevating and sustaining the quality of care; assuring equity for all, using data for action, increasing investment in maternal health, ensuring a competent and motivated health workforce, ensuring response and resilience, making commodities available, demanding accountability and facilitating research, innovation and knowledge exchange.

Last week, key custodians of maternal health, the Kenya Obstetrical and Gynaecological Society (KOGS) in partnership with Amref Health Africa, Kenya, and USAID, under the banner of “Uongozi wa Afya Thabiti” project, came together at the 48th KOGS Annual Scientific Congress to set in motion an ambitious plan to honour the commitment to deliver on the WHO EPMM roadmap for Kenya.

The project aims to leverage on strategic partnerships to bring together all stakeholders that are committed to reducing preventable maternal and newborn deaths in Kenya, under the umbrella of the Ministry of Health, to deliver on this promise.

It is truly a moment when the stars align for the women and girls in Kenya, where the technical leaders of maternal health, the gynaecologists, are in positions of decision-making and influence: the Director General of Health; the head of the Family Division in the Ministry of Health; the CEO of the Kenya Medical Practitioners and Dentists’ Council; and even the current president of the International Federation of Obstetricians and Gynaecologists is from Kenya.

With all these key decision-makers and influencers in place, surely, we must ensure maternal health is prioritised and that we turn around the statistics for Kenya. We must commit that our mothers and newborns must live! The KOGS-AMREF-USAID partnership endeavours to bring together and build cohesion among all partners in the maternal health space so that their work is complementary and the impact magnified rather than the current state where every partner is working alone in a silo, with far less impact.

We have six years to make it count; six years to tame the situation, from 350 maternal deaths per 100,000 live births to below 70. Can we do it? Yes, we can. We just need commitment!

Dr Bosire is an obstetrician/ gynaecologist