Classic case of maternal death: Why we failed Maureen Anyango

The recent investigative report by the Senate on the death of Maureen Anyango, a patient of Mama Lucy Kibaki Hospital in Nairobi, is a stark reminder of a problem that continues to afflict our women – maternal mortality.

Ordinarily, you would expect statistics on the same in the Kenya Demographic and Health Survey Report. Unfortunately, the 2022 version does not include such data, hence the only reliable figures available are those for 2007–14, at 362 deaths per 100,000.

According to the Senate report, Maureen waited for eight hours before getting any attention, notwithstanding that she was a first-time mother pregnant with twins and in active labour, conditions that dictated emergency caesarean section.

Profuse bleeding and high blood pressure culminated in shock. When taken into the theatre, Maureen was subjected to general anaesthesia, which did not reverse, leading to being placed on mechanical ventilation.

Unable to deal with the situation, the staff referred her to Kiambu Level 5 Hospital; but again there was an eight-hour delay in executing the transfer!

The 20-kilometre journey took a whole two hours for a distance that should take just minutes, especially in an ambulance.

While in transit, the nurses realised that the oxygen cylinder at hand was empty; and they did not have a wrench to open the alternative one! Bagging her with room air resulted in hypoxia (inadequate blood in tissues), thus she was unconscious and in critical condition on arrival. Maureen died.

The committee chided Kenyatta University Teaching and Referral Hospital for demanding a down payment of Sh200,000 as a precondition for admitting Maureen for intensive care.

Critically speaking then, Maureen died because of a combination of casual attitude, inertia, inadequate facilities, ineptitude, poor technical decisions and poverty.

Maureen’s case is a reminder of the 1988 World Health Organization video, Why Did Mrs X Die? This clip catalogues determinants of maternal mortality, conceptualised as a journey along the “maternity death road” with various exits, which, if blocked, push women back to danger.

Mrs X is taken to a small district hospital in labour where she is clinically diagnosed with antepartum bleeding due to placenta praevia.

She is experiencing life-threatening complications, manifested in bleeding, toxaemia, sepsis and obstructed labour. An obstetrics study discovers that Mrs X received inadequate blood because of insufficient stock.

She was also taken for a late caesarean operation, like Maureen, due to the hospital’s poor capacity to handle emergencies. These factors terminally blocked her exit from the road.

Poor infrastructure

A retrospective community-based study reveals that Mrs X reached the hospital late because of poor transport infrastructure.

She was a victim of two previous instances of minor bleeding, a sign of potentially more severe episodes, which, if detected earlier, could have led to referral.

She was also a sufferer of chronic anaemia, malnutrition and low blood levels. The study concludes that Mrs X died because of women’s unmet needs for maternity care.

If such were available, her deteriorating health condition could have been detected and remedial action taken. This exit was not available for Mrs X.

A reproductive age mortality study notes that Mrs X was 39 years old, already had five children and any additional pregnancy was actually a risk. But because children were the principal denominator of her social worth, she had to continue giving birth.

A demographic study shows that Mrs X was a housewife. Her spouse was no better, being an agricultural labourer residing in a remote rural area. In principle then, she died because of patriarchal norms, poor knowledge of and access to family planning information and services, and low socioeconomic status.

The video advises that maternal mortality should be tackled at all the levels of causality. Emphasising only the medical exits is not adequate. In fact, tackling the socioeconomic factors would decisively block women’s tragic journey on the maternity death road.

If we addressed poverty, improved women’s socioeconomic status, ensured equitable distribution of resources, reduced gender inequalities and achieved social justice, maternal deaths would be close to a myth.

If we invested in the education of girls and women, and improved access to sexual and reproductive health education, information and services, maternal deaths could be drastically reduced.

And if we had professional and adequately equipped facilities and referral services, we would respond expeditiously to life-threatening conditions and literally pluck women from the jaws of death.

The system failed Maureen when she was at the dark end of the tragic road. After 60 years of independence, should we still be losing women in such a manner? The video states, and we agree, that women at the dark end of the maternity death road “need to be saved, can be saved and must be saved”.

The writer is an international gender and development consultant and scholar ([email protected]).