Reflections on Maternal Healthcare and Maternal Mortality in Kenya

maternal

AN OPEN LETTER TO H.E UHURU MUIGAI KENYATTA
I am honoured to have the opportunity to write to you. I must admit that I am inspired by your energy and enthusiasm to lead our country and to deliver on the promise of a new Kenya. I have no doubt in my mind that you will deliver on your promise. May the almighty God provide you with wise counsel as you journey through the process of healing and building our country. May he sustain you through the challenges that come with the task that is ahead of you.
Allow me to provoke your thought on the state of Maternal Healthcare in Kenya as one of the sectors of our development that need swift and urgent attention by your Excellency’s government.
I know of your government’s commitment to abolish maternity fees in Kenya within the 1st 100 days in office. This is a move that deserves huge applause seeing that thousands of women will henceforth access maternities to ensure that every Kenyan child is born in the safety of a hospital. However, this move alone cannot and will not solve the challenges we face with our maternal healthcare systems. This move alone will not help us save the lives of the many infants and pregnant mothers we lose every year to pregnancy related complications.
The 5th Millennium Development Goal (MDG 5) to reduce maternal mortality by 75% during the period 1990-2015, is by far the least MDG on track to be fulfilled in Kenya as in most of Africa. Women continue to suffer and die unnecessary disabilities because of complications of pregnancy. According to the 2009 Kenya Demographic and Health Survey (KDHS) the current ratio of maternal deaths in Kenya stands at 488 deaths per 100,000 births, a sharp contrast from developed countries that register less than ten deaths per 100,000 births.
This is a matter of great concern, as these deaths arise from well-known preventable causes-obstructed labour, complications of unsafe abortion, infections, haemorrhage and high blood pressure. Yet all these are treatable. In fact pregnancy is not a disease. With skilled health care during pregnancy and delivery, provided in an adequately supplied and equipped health facility, these premature deaths can be prevented.
The ambiguity in the jubilee coalition’s manifesto on the solutions to the challenges facing the healthcare system in Kenya and in particular maternal healthcare is overwhelming. While your coalitions manifesto clearly underscores these challenges, it is not very clear on the specific interventions and key performance indicators laid out to improve the maternal healthcare system and save the lives of our women.
Allow me to point out a few of the challenges that bedevil our maternal healthcare system and offer my two sense solution.
In general, 15% of all pregnant women are at risk of serious obstetric complications. All pregnant women should therefore have access to quality basic or comprehensive emergency obstetric care.
Obstetric care in Kenya is limited, especially in rural areas where the majority of women live. The services that are available, whether provided by the government or private medical practitioners, are mainly concentrated in urban areas, and are thus inaccessible to the majority of women. Maternal health facilities in Kenya are also often poorly equipped and lack important components of maternal health, i.e., normal delivery, postnatal care and emergency services (NCAPD et al., 2004). This means that even in cases where the mother gets to the health centre, there is no guarantee she will get the services she needs whether for free or at a fee.
The risk of death for mothers is highest immediately after delivery (the 48 hours after delivery). Postnatal care is therefore essential to prevent complications after childbirth. Only 42% of women receive postnatal check-ups within two days of delivery, and more than half of women who give birth do not seek postnatal care. These figures are worrying, given that pre- and postnatal care are critical to women’s health. The mothers mostly affected are those in the lowest wealth quintile, those with low levels of education and those in remote areas like North Eastern Province where 79% of women do not receive postnatal care. Targeting services to such areas would potentially have a great impact on mortality levels.
The risk of maternal death increases with each pregnancy, and with pregnancies that are too close together. Satisfying women’s unmet need for family planning, that is, ensuring access to contraceptives by women who want to space or avoid pregnancies but are currently not using contraception, could reduce unintended pregnancies, unsafe abortions and maternal deaths.
Kenya continues to have a high unmet need for family planning. About a quarter of currently married women who want to space or limit their births are not using any form of contraception. Access to modern contraceptives would enable women to avoid unwanted and too many pregnancies, which can lead to unsafe abortions and complications associated with too many births. It could also reduce maternal deaths by more than one-third (UNFPA and Guttmacher, 2009).
Antenatal, delivery, postnatal and other obstetric care services provided in public health facilities are substandard. Service provider harassment and mistreatment of women in public health facilities in Kenya is reportedly rife. Providers are not only frequently unfriendly to women, but also regularly fail to answer their questions, ask them for important routine information or counsel them during antenatal care consultations.
Many if not most service providers also lack more advanced skill, for example recognizing and treating life threatening complications. It is important to improve the performance of health care providers by increasing training opportunities and making them accountable to the public.
Kenya’s public health sector capacity to respond to the needs of women is limited. The sector is under-financed and characterized by shortages of most basic essentials. It frequently suffers stock-outs of medications and basic supplies including contraceptives, shortage of personnel and a lack of key equipment.
Investing in health systems is critical to the improvement in maternal health and achievement of the MDGs. Perhaps more to the point, as indicated above, if adequate family planning services were available there would be fewer unintended pregnancies and thus much less demand for induced abortions.
It is possible to reduce maternal deaths if women have access to skilled attendance at delivery, emergency obstetric care when needed and family planning. This would go a long way in reducing mortality and improving the health of women, and as a result move Kenya closer to achieving the MDG 5 targets on maternal health and the goals of Vision 2030.
Political and financial commitment is needed to ensure maternal health is protected. Strengthening health systems to ensure the country can deliver proven interventions effectively is critical. We must Increase government allocation for contraceptives to ensure that women who want to space or avoid pregnancy have access to modern contraceptives. The government must also provide adequate and sustained government funding for maternal health, mainstream the output-based approach project piloted in Nairobi, Nyanza and elsewhere, train health workers appropriately to improve client relations and quality of care, make health providers more accountable to the public in order to improve their performance, e.g., through enforcement of Citizen Service Charters and individual performance contracts with the government, enforce existing laws and policies against early marriages and female circumcision.
These solutions are by no means comprehensive. There are a myriad of other things the government can do to improve the state of Kenya’s maternal healthcare. But more importantly we must make sure that we protect our women and babies. Few or no lives should be lost to pregnancy related complications.
Every Kenyan is guaranteed the right to life in Kenya’s Constitution and the government has a duty to protect each life no matter what.

Yours faithfully
Concerned citizen

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