Live update: Senators discuss governors snubbing summons
Kenya must make prevention the heart of maternal and newborn care
The country loses approximately 13 to 15 women each day due to pregnancy-related complications such as excessive bleeding, preeclampsia, and infections – all of which are largely preventable.
What you need to know:
- If preconception care had been part of her routine primary health care, Rachel’s first delivery would not have marked the end of the story. It would have been the beginning of recovery.
- The heavy bleeding that followed would have triggered follow-up. Her anaemia would have been diagnosed, treated, and monitored.
Recently, I was in the field conducting a review of a maternal and newborn health project. The setting was beautiful: a rural landscape of green hills, warm air, and a community proud to welcome visitors. There was singing, dancing, and smiles all around.
As we settled in for the village health baraza, my attention kept drifting to something just beyond the gathering: a mound of fresh earth and a wooden cross. The unmistakable mark of a recent burial. Curious, I leaned toward Sarah, the community health promoter beside me, and quietly asked the question. She inhaled sharply, nodded, and whispered that she would explain later.
Three hours later, after the speeches and discussions were over, she pulled me aside. Her voice trembled as she recounted Rachel.
Rachel was 19. She had an 18-month-old child and was 38 weeks pregnant with her second. She had done many of the 'right' things: she attended her antenatal clinic visits and took her iron and folic acid supplements faithfully. But when she arrived at the health centre in labour, something was terribly wrong. She was dangerously pale. Paper-white, Sarah said.
Rachel explained that she had bled heavily during her first delivery. After that birth, she never received treatment, supplements, or follow-up care. She became pregnant again before her body had recovered. During labour, she was too weak to push effectively. The baby was born as a fresh stillbirth. Moments later, Rachel began to bleed profusely. Before the health centre could mobilise a response, she went into shock and died.
Two lives were lost in minutes. This was not an unpredictable tragedy. It was a system failure that unfolded quietly over months.
Kenya’s maternal and neonatal mortality rates have remained stubbornly high despite years of targeted interventions. Financial barriers to facility delivery were reduced. National campaigns were launched. Advocacy reached the highest levels of government. The maternal and newborn health agenda rightly focused on the leading causes of death.
Yet, most systems remained geared toward responding to emergencies rather than preventing them. Rachel’s story lays bare the failures of this approach.
More recently, Kenya has begun to change course. Policymakers and practitioners are placing renewed emphasis on preconception care and a true continuum of care across pregnancy, childbirth, and the postnatal period. This shift is rooted in primary health care and reinforced through Primary Health Care Networks that link community units, health centers, and referral facilities into coordinated systems.
If preconception care had been part of her routine primary health care, Rachel’s first delivery would not have marked the end of the story. It would have been the beginning of recovery. The heavy bleeding that followed would have triggered follow-up. Her anaemia would have been diagnosed, treated, and monitored. She would have received counseling on birth spacing, nutrition, and the timing of her next pregnancy. Pregnancy would not have begun on depleted reserves. Quality antenatal care, delivered within a strong primary health care system, would have flagged her dangerously low blood levels early. Referral would not have come as a frantic last-minute scramble but as a planned and supported pathway. And within the Primary Health Care Network model, specialist input could have arrived through structured case review, rather than in the delivery room, when her life was already hanging in the balance.
Preconception care remains one of the most neglected areas in maternal health, yet it is among the most effective. Improving nutrition before pregnancy lowers the risk of stillbirth, the likelihood of babies born with low birth-weight and life-threatening maternal complications. Treating infections early prevents adverse outcomes later.
Managing chronic illnesses, supporting mental health, and enabling informed reproductive choices all shift risk upstream, where it is easier and cheaper to address.
Prevention is a “best buy” not because it is cheap, but because it avoids irreversible loss. The question is not whether this approach works. It is whether the systems are designed to deliver it every time.
Primary health care networks provide that opportunity. When properly supported, community health promoters are the connective tissue of prevention. They know who has recently given birth, who has become pregnant, and who missed a follow-up visit. With tools like the electronic community health information system, these insights can move from memory to action. Follow-up becomes systematic rather than heroic. Women at higher risk are identified early. Referrals are tracked. No one quietly falls through the cracks.
Technology alone, however, is not enough. Sustainability depends on predictable financing, protected time for health workers, and accountability that flows both upward and back to the community. Prevention depends on trust. Women must believe that seeking care early will lead to care, not dismissal. Health workers must believe that doing the right thing will be supported, not punished.
As the country rallies partners under the umbrella of Every Woman Every Newborn Everywhere, Kenya must fully commit to prevention as the organising principle of maternal and newborn health. The country loses approximately 13 to 15 women each day due to pregnancy-related complications such as excessive bleeding, preeclampsia, and infections – all of which are largely preventable. This can be achieved through preconception care, which needs to be routine within primary health care, not treated as an optional add-on.
Primary Health Care Networks must be resourced to function. Community health promoters must be paid, equipped, and taken seriously. Data must be used locally, quickly, and humanely. If we continue to build systems that wait for tragedy, we will keep failing women like Rachel – and that is unacceptable. Prevention is not an expression of idealism; it is a matter of responsibility.
Dr Muthigani is a medical doctor and senior public Health specialist and advisor
