System and governance failure: Why Kenyan mothers are still dying in childbirth
A mother is diagnosed with PPH if she loses over 500ml of blood after vaginal birth or 1,000ml of blood during a caesarean section.
What you need to know:
- With Kenya’s maternal mortality rate currently standing at 355 deaths per 100,000 live births, health experts are united in their verdict, this is unacceptably high for a nation that possesses both the infrastructure and the expertise to do far better.
Across the country, mothers are dying; not because their doctors lack knowledge or their nurses lack training, but because the systems meant to save them are failing. Health workers are too few. Referrals take too long. Blood is unavailable when it matters most. And when a mother’s life hangs in the balance, the right decisions are often not made fast enough.
These were the hard truths laid bare this week at the Kenya Obstetrical and Gynaecological Society (KOGS) annual conference in Mombasa, where the country’s top doctors, gynaecologists, and health leaders gathered to confront a crisis that is both persistent and preventable.
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What emerged from the discussions was sobering: the problems driving maternal and newborn deaths in Kenya are not new. They have been documented, discussed, and decried for years. Yet year after year, they remain the leading causes of death; pointing not to a failure of clinical knowledge, but to a deeper, systemic failure that continues to cost lives.
Health Director General Dr Patrick Amoth, a keynote speaker at the conference, did not mince words about where the failures begin. A mother’s chance of surviving childbirth, he reminded delegates, is shaped long before she enters a delivery room; by decisions made from the moment she conceives, throughout her pregnancy, and right up to the final moments before delivery.
"Lack of knowledge, poor financing, delays by a mother to access a health facility, and delays by a health worker to attend to a client, all have a heavy impact on maternal health outcomes," Dr Amoth said.
The message was stark: when a mother delays seeking care, or when she arrives at a facility only to wait too long to be seen, the consequences can be fatal.
With Kenya’s maternal mortality rate currently standing at 355 deaths per 100,000 live births, health experts are united in their verdict, this is unacceptably high for a nation that possesses both the infrastructure and the expertise to do far better.
The national government has pledged to work more closely with county governments to close the governance and accountability gaps that continue to cost mothers their lives. But pledges, as many in the room knew, are not enough.
What is needed is action: faster referrals, better-stocked facilities, more health workers, and a system that responds decisively when every second counts.
According to the Ministry of Health, postpartum haemorrhage (excessive bleeding after childbirth) remains one of the leading causes of maternal deaths in Kenya.
Dr Amoth noted that while Kenyans continue to donate blood in significant numbers across the country, weak infrastructure often makes it nearly impossible to get the life-saving commodity to mothers who need it most. The gaps, he explained, span the entire supply chain; from screening and transportation to timely delivery at the bedside.
“For a very long time, Samburu County did not have a blood transfusion centre, forcing mothers and health workers to travel all the way to Nakuru—a distance of more than 200 kilometres—to access blood,” Dr Amoth said. “Imagine an expert having to travel from Maralal to Nyahururu just to collect blood and rush back to save a mother’s life.”
Despite these logistical hurdles, he pointed to progress in public willingness to donate. “Last year, we collected 101,000 pints of blood, surpassing our target of 80,000. This shows that Kenyans still have the zeal to donate. We are now focused on strengthening the infrastructure to ensure a smooth flow of services.”
Also present at the event was the chairpersonr of the County Executive Committee Members (CECMs) for Health, Dr Gregory Ganda, who said that every maternal death often points at a system failure.
According to Dr Ganda, preventable maternal and neonatal deaths is always a governance failure,before it becomes a clinical failure.
“Somewhere in Kenya, a woman is going to die today while trying to give birth and sadly, one of us in this room could have saved her. The question is not the skill, but whether our system allows the skill to reach her on time,” said Dr Ganda.
Dr Ganda, also the Kisumu County CECM for Health, said while a woman may have made it to the hospital for a skilled delivery, a lot of factors may affect the pregnancy outcomes.
While there might be a health worker to attend to the client, lack of knowledge of what to do to stop bleeding due to a lack of mentorship still stands as a barrier.
“The system of blood donation, referral, lack of equipment and staffing may fail the mother. Imagine an instance where an expert wants to conduct an operation but the drips are not working, a procedure is being delayed because of a specialist who rarely reports to work and a failed oversight system that never holds the involved staff accountable,” said Dr Ganda.
He added: “Over time, all of us in this room have learnt that when a medic delivers a healthy baby, he or she is not the only hero. So much goes on, starting from the lowest level of the nurse who did the antenatal care clinic,”
Dr Ganda,, however, lauded the role of inter-county Maternal and Perinatal Deaths Surveillance and Response (MPDSR), a peer-to-peer learning and accountable system connecting frontline health workers in all the 47 counties, the national referral and county and national leadership in reducing the preventable deaths.
With the help of the system, he said, 37 counties are currently running weekly reviews of maternal child health, sharing dashboards for comparisons, shared mentorship engagements and hosting of national webinars based on crosscutting themes.
While sharing a presentation on the impacts of the intercounty MPDSR, Dr Grace Wanjiku, a consultant obstetrician and gynaecologist in Murang’a, said the county’s fifth mortality rate currently stands at 133 per 100,000 live births.
In 2025, she said, out of the 18,000 deliveries in the county, only 26 maternal mortalities were reported.
“Reliable commodity availability is one of the key reasons behind the positive outcomes,” said Dr Wanjiku.
Dr Ganda argued that as much as the health services are devolved, patients and referral pathways are not, thus the reason behind women and newborns traversing counties in search of care.
He, however, cautioned that MPDSR remains incomplete unless it examines the full patient journey across the counties and facilities involved in care.
“We want to learn from each other through the system so that the mistakes made in one county are not replicated,” he said.
Dr Amoth said in order to improve maternal and child outcomes, the national government is going to work closely with the county government in capacity building and training of health workers, commodity supply, equipment and workforce availability to ensure a smooth flow of services.
The government, he said, is also working to address governance and accountability gaps through setting up and strengthening maternal and perinatal death surveillance responses.
“We have also decided to come up with a rapid result initiative to address the increasing burden of maternal and newborn mortality while prioritising the 26 counties which contribute more than 60 per cent of maternal and newborn deaths across the country,” he said.
Dr Amoth further disclosed that, with support from partners, the government is revamping the regional blood transfusion centre in Garissa to serve the neighbouring counties of Tana River and Wajir, areas where geographical isolation has long delayed access to emergency blood supplies.
He also highlighted a critical shift in how health data is collected and used. In the past, the government relied on the demographic health survey—conducted every five years—to inform decision-making, a lag that often derailed timely interventions in maternal and child health. The introduction of a digital health system in facilities is now changing that.
“One of the challenges with waiting five years for data is recall bias: experts often struggle to remember the exact causes of death,” Dr Amoth explained.
“As we speak, level four hospitals and above are already transmitting real-time data, thanks to the new system. We are now working to digitise level two and three facilities.”
During the conference, the government also launched the first Basic Obstetric Protocol 2026, a landmark resource designed to offer evidence-based, practical guidance to healthcare professionals at every level of service delivery.
According to KOGS President Dr Kireki Omanwa, the protocols will address seven priority conditions in maternal health: obstructed labour, sepsis, abortion care, anaemia, antepartum and postpartum haemorrhage, and hypertensive disorders.
“These pocket-friendly booklets will be distributed to experts across the country in a concerted effort to reduce maternal and child deaths,” Dr Omanwa said.
