What it will take to significantly reduce maternal deaths in Kenya

What Gladys Mbone Omudi experienced when she went to deliver her third child in a public health facility 35 years ago has left her traumatised to this day.

"I am a mother of 15 children, but I have delivered my last twelve at home with the help of traditional midwives. Even if I were to fall pregnant today, I would stay away from the hospital because I almost lost my child due to inconsiderate and unprofessional hospital personnel,” says the 56-year-old from Korogocho, Nairobi.

She shared her story at a high-level dialogue on quality, equity, and dignity in maternal and newborn health (MNH) on December 11. The dialogue, held at the Windsor Hotel and Golf Club, was organised by the White Ribbon Alliance Kenya in partnership with the United Nations Population Fund (UNFPA).

The meeting, themed "From Promise to Action and Accountability for Mothers and Newborns," was necessitated by the alarming rate of maternal deaths. According to the Kenya Population and Housing Census Report (2019), the country loses 355 lives for every 100,000 live births due to complications during pregnancy and childbirth. At the current annual birth rate, this means that nearly 5,000 women and girls die every year.

“I got my first child, who is currently 40 years old, when I was only 16. I went to a public health facility, and the experience was so bad because after delivery, I tore badly and lost so much blood, but I wasn’t attended to until eight hours later,” she narrated.

For her third pregnancy, she went to the hospital when she went into labour, but she was turned away.

“I was denied admission because I did not have a basin, a roll of cotton wool, and disinfectant. Instead, they admitted the other women behind me who had the items. At that very moment, I felt the urge to go to the toilet, and that is how I ended up delivering my child in the toilet—my child almost went down the toilet hole,” she said, holding back tears.

Ms Omudi’s story is not an isolated case, and the irony is that four decades on, the situation hasn’t changed much.

“When I went to deliver my three-month-old baby in late September, I met very hostile medics who insulted me and made me hate the experience. After delivery, I was bleeding a lot and my efforts to seek the doctor’s attention fell on deaf ears. I was only assisted when I grew extremely weak and my wardmates threatened to protest,” narrated Mercy*, a teen mother.

The day’s MC, radio personality Masawe Jappani, painfully recounted how she lost her first child at the age of 23. “I went to the hospital in pain, but I was turned away and told I was not ready for delivery yet. I returned home and spent the night, but my child stopped moving. I woke up and headed to the hospital, and upon checking, I had a stillbirth. My child was 40 weeks old, and I believe that if I knew my rights then, I would have questioned when I was told to go back home, and I believe my child would have survived,” she said.

The dialogue brought together maternal healthcare survivors, policymakers, and shareholders to present the findings of listening exercises on what women and midwives want for respectful and dignified care, a key precursor to quality care that is essential for good health and well-being.

Findings from recent studies conducted by the White Ribbon Alliance Kenya listed the top five demands from women across the country. The demands are: respectful and dignified care; water, sanitation and hygiene; adequate medicines and supplies; increased number of competent and better-supported midwives and nurses; as well as more fully functioning and close-to-home maternal health facilities.

Representing the Ministry of Health (MoH), Dr Charles Kandie emphasised MoH's commitment to empowering communities to demand quality services from health facilities. “We are also modernising education for healthcare professionals because we want them to prioritise humanity. We are aware that women want safe deliveries and effective and timely care, and as a ministry, we are committed to this,” he said.

A passionate appeal for blood donations was also made. “I want to see safe blood for transfusion available to any woman who needs it while giving birth. Post-partum haemorrhage remains a leading cause of maternal mortality in this country. Let all [maternity] facilities have access to blood for transfusion or be able to refer a bleeding mother to where she can get a life-saving transfusion,“ said Dr Caroline Wangamati, the lead for Coalition of Blood for Africa (COBA).

Ms Florence, who runs a care centre for teenage mothers, decried the treatment that teen mums receive in health facilities. “They are treated like grown women which is quite unfair because these are still children. They are still trying to understand what is happening to them yet they are mishandled and talked down to. These experiences might force them to stay away from hospitals, and this could lead to maternal deaths”.

According to Angela Nguku, the executive director and founder of White Ribbon Alliance Kenya, the high-level dialogue on maternal and newborn health was timely as it has been over a decade since county governments committed to improving maternal health, but the change has been slow.

“We have the opportunity as a nation to bring all stakeholders together to intervene [on behalf of] women and their newborns, with women and communities leading the way and providing the voice. This is an opportune moment to power up communities, private and civil actors, government and the broader society for better maternal health,” she said.

The dialogue culminated in the signing of commitments to reduce the number of maternal deaths by the various stakeholders represented in the meeting.

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