Strength of a Woman - Maternal Health Special

Strength of a

Woman September 27, 2010

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We need to keep our promise of a healthy world for all women and children.

To deliver this promise we must address more than health inequalities. We must address discrimination of all kinds.

Gender inequality is a danger to women’s health.”

— Ban Ki Moon

The untold stories of Maternal Health & Death

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When your mother dies, if you do not start crying no one will cry with you.

Africa should not expect other development partners to put money for maternal mortality if they do not priorities maternal in their budget. — Dr Fred Sai

September 27, 2010

Strength of a

Woman

EDITOR’S Chat

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young woman who at only 36 already has 23 children. She started giving birth at 15, at a time when her body was not ready for motherhood. She has never been to hospital. She does not know what ante-natal care is all about because she has never been attended to by a skilled health worker. Yet she has given birth to eight sets of twins and had seven single births with only the help of a traditional birth attendant. There is no sign that she will stop giving birth soon. Her husband says she must continue to eternity. He bars her from using any family planning method. She is now worried that her body cannot carry another pregnancy. She fears that soon she will die on the mat where the traditional birth attendant has helped her in 21 years to deliver her 23 children.

This story forms part of many others that include men who find themselves alone with babies whose mothers died on the labour table. They have no clue of what to do with the children.

These are stories of grandmothers who have been taken back to motherhood after their daughters died when having babies. These are stories of failed policies and of ignorance, of lack of political commitment, inefficiency and unprofessionalism.

This special issue that looks at what is happening to women who are giving birth under various circumstances and who in one way or another leave behind untold suffering.

These are human stories told by families that suffer when the mothers die under circumstances that could have been stopped.

These are the human stories that starkly reveal the conspiracy to deprive women of access to maternal health care and facilities. It is just a conspiracy of death.

They could not have been told in any other way.

The stories were produced after the African Woman and Child Feature Service through the Media Diversity Centre held a two day training for journalists from its content centres on how they could write reproductive health stories with a difference.

Contents Kenya engages reverse gear on maternal health

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Family at loss over mother’s death

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Women camp in hospitals to access skilled birth care

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Kenya engages reverse gear on maternal health

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The pain of spontaneous miscarriage

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With the right support, maternal deaths can be prevented 8 Lucky are those men who have families to support them

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Sharing of beds is the norm at Naivasha Hospital

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Putting professionals at the centre stage

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Empowering the TBAs

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Insurance cover for cervical cancer

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Ring-fencing protects health sector

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Mothers find hope in make shift incubator

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The north follows the footsteps of foremothers

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Boda boda ambulance comes to the rescue

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Mothers find hope in make shift incubator

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Expensive maternity costs sending mothers to TBAs

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Tragedy of hope gained amidst loss

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Gates takes the lead in jumpstarting funding for maternal health

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Orphans still miss maternal love

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Report links TBAS to rise in obstetric fistula

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FGM hampers safe delivery

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Myths hinder women from accessing attention on time

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Project Editor: Jane Godia

Smart card introduced to ease maternity services

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Sub-Editors: Florence Sipalla and Mercy Mumo

Technique encourages women to seek skilled care

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Only a partnership can stop the deaths

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Why ante-natal care remains a necessity

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36 years old with 23 children

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Gap in maternal health remains conspicuous

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Enjoy reading.

Jane

The Team Executive Director: Rosemary Okello

Designer: Noel Lumbama Contributors: Godfrey Machuka, Akumu Ajiambo, Musembi Nzengu, Ryan Mathenge, Valerie Aseto, Faith Muiruri, George Murage, Abjata Khalif, Jane Mugambi, Frank Olero, Oloo Janak, Duncan Mboya, Ajanga Khayesi, Jane Kithumba, David Njagi, Ben Oroko, Michael Oongo, Doseline Kiguru, Muasya Charles, Mary Amuyunzu and Venter Mwongera.

Strength of a

Woman

September 27, 2010

When a woman prospers, communities prosper. Women deliver for the world and it is now time for the world to deliver for women.

— Hillary Clinton

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EDITORIAL

Parliamentarians must deliver for women

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s people’s representatives, time has come for Parliamentarians to turn debates into action and commit themselves to work as legislators.

They need to mobilise support and legislate actions to ensure the health, dignity and rights of women and girls. These policies that they will put in place must address maternal and reproductive health.

Ten years review of the MDGs, it is, even though

countries such as Rwanda, Ethiopia, have made progress, Kenya has not made any advancement.

The figure of women dying in preventable and curable diseases seems to be getting bigger every day.

This need not be the case, saving women’s lives should be top priority to any politician. Why so?

Because despite the fact many of our leaders might have been born at home with just the simple help of

a traditional birth attendant, the women of Kenya are the only source for making sure politicians are guaranteed of their votes because of their role as women.

The Members of Parliament have a duty to translate global action into local reality through creation of laws and policies which will ensure health solutions for women and girls. This must be complemented by a conducive political and legislative environment to ensure long-term results.

The legislators should also ensure that the overall health budget is increased. They must guarantee that the Ministry of Medical Health establishes realistic and verifiable annual plans for achieving the targets of MDG 5.

The MPs can also demand that the Government comes up with a comprehensive framework on maternal health as well as road map before the annual budget is read. This way the Government will be forced to plan for resources on maternal health.

Parliamentarians have got the clout and ability.

They hold the key that could change the tide for women and make their voices heard in the fight against maternal mortality. They need to keep the promise they made to the voters by making sure the Government maintains a healthy Kenya for women and children to enable them fulfil their potential.

The women of Kenya have delivered their promises, it is time parliamentarians step in and make sure that as Kenya enters into the new constitutional dispensation, they will join hands with the government, CSOs, experts and development partners in making sure that there is an end the silent scandal of women dying in childbirth. No woman should pay with her life for giving life.

A pregnant mother at the Coast General Hospital where she had gone for ante-natal care. Kenya has not made any progress in meeting the MDGs target on reducing maternal mortality ratio by three quarters.

— Picture: Correspondent.

Kenya engages reverse gear on maternal health

By AKUMU AJIAMBO “I went into labour when I was tilling in a farm where I worked as a casual labourer. My colleagues at the farm rushed me home where the traditional birth attendant was waiting for me.

“I was in labour for several hours, I think it was four or five, I am not too sure. During that time, all she did was shout at me, castigating me for being lazy and not pushing the baby out. At some point she literally slapped my thighs forcing them open while pushing me to the wall of my mud walled hut and ordering me to push,” recounts Lillian Ambasa of her experience in the village.

Ambasa a domestic worker in Nairobi’s Buru Buru Estate and a mother of three says delivering her last

born child at home was a horrific ordeal.

“I delivered the first two children at Pumwani Hospital here in Nairobi. But we were forced to relocate to Kangundo, my husband’s native home after he lost his job as a kitchen hand in Nairobi,” says Ambasa. She adds: “We were both tilling people’s farms to earn money which was not much, so the option of delivering in hospital was not open to us. I was told by my mother-in-law that with the TBA I could pay in instalments or in kind. So I took that option.”

Although she eventually delivered safely after several hours of labour pains and without skilled help, Ambasa firmly believes, her experience would have been different had she been in a hospital.

According to recent trends of maternal deaths released by the UN, Kenya is among 11 countries which accounted for 65 percent of all maternal deaths in 2008. In this category Kenya is in the company of countries such as Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Sudan and the United Republic of Tanzania.

In these countries, pregnant women still die from four major causes: severe bleeding after childbirth, infections, hypertensive disorders and unsafe abortion.

The UN report states about 1,000 women died due to these complications everyday in 2008. Out of the 1,000, 570 lived in sub-Saharan Africa.

Government figures show the rate of maternal deaths in Kenya is increasing from 414 per 100,000 live births in 2003 to 488 per 100,000 live births in 20082009.

One of the reasons blamed for this has been the number of women delivering at home without the help of skilled health care attendants.

Such is the case of Ambasa where in unfortunate situations, the TBAs do not heed to complications and often let the women labour for long hours leading to fatalities.

With only five years left to the deadline of attaining Millennium Development Goals (MDGs), experts say CONTINUED ON PAGE 6

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The moment a child is born, the mother is also born. She never existed before. The woman existed, but the mother, never. A mother is something absolutely new. — Rajneesh

September 27, 2010

Family at loss over mother’s death

Strength of a

Woman

By Musembi Nzengu

Grandmother Lydia Misuvu, in her 80s, has a meal with her grandchildren. The old woman has been left to take care of the children after their mother Mary Ndanu died giving birth.

— Picture: Musembi Nzengu

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t is almost three months since 28-year old Mary Ndanu passed away on a theatre table at the Mwingi District in June.

Ndanu from Kiisu Village, Nguni Division, Mwingi East District died from a botched caesarean section by a doctor who is said to have been drunk on the job.

Although the late Ndanu, who left behind five children, has since been buried, her immediate family members have not come to terms with her untimely death.

Her five children aged between 11 and one and a half years are oblivious to her passing away. They have innocently but incessantly been enquiring about her whereabouts.

Yuma Benjamin (11), David Kilonzo (8), who is in Standard 4 at Kiisu Primary School; Amos Mutisya (6) in Standard Two, Naumi Misuvu (3) in pre-school and Josephine Kathembwa who is only one and half years old cannot understand how their mother could have disappeared without trace.

After failing to get love, care and pampering from their mother, the children have become a bother to their father, Mr Titus Emannuel Yuma, 38,

and 78-year-old grandmother Ms Lydia Misuvu with relentless demands for explanations on what became of their dear mother.

During a recent visit to Kiisu Village, we found Yuma who said he has had problems explaining to the inquisitive children why their mother has been unusually absent from home for a long time.

Secrecy “Family members decided to keep the information about Ndanu’s demise secret. The issue has not been discussed openly with the children.

“Whenever they make inquiries, I always tell them their mother was in Mombasa running errands and would be back home one day,” says Yuma during our evening visit.

Recently, he was shocked when his son David came home from school and posed a question that obviously indicated that he had information that his mother had died contrary to the assurance he had been giving them.

“He came running from school and found me resting on a stool outside my house and without any warning asked ‘Dad is it true mum died?’ I was

devastated and for a moment was at a loss of what to tell him,” explains Yuma.

Although he gathered the courage to assure his son that their mother was safe in Mombasa, the young one appeared cynical. The boy was not convinced by the answer his father gave.

“Kilonzo’s question came as a surprise because I had all along thought information about their mother’s death would never be known to them,” says Yuma.

The children’s grandmother says although she had taken the role of feeding the children especially Josephine, who is the youngest, she has always shown some resistance.

“Many a times she turns down my efforts to feed her and out of the blues demands to know her mother’s whereabouts. She misses her and wants the mother to feed her as she had done previously,” says Misuvu.

The old woman has been forced to lie any time the children make inquiries about their mother’s absence.

Although it is not known how long it will take before the children learn about their mother’s the death, keeping the information secret is not the only

dilemma the family has to contend with.

It has since dawned on the aging Misuvu that fitting in her departed daughter-in-law’s shoes is an uphill task.

The responsibility of fending for the partially orphaned children has been enormous since their mother passed on and she admits that it is wearing her out fast.

New responsibilities “I have been forced to take up some chores that I did about 40 years ago when their father was a toddler. For many years I have neither cooked food nor bathed young children…with my failing sight and aching back the tasks are just impossible,” says Misuvu as she cuddles Josephine.

Soon after her daughter-in-law’s death, the old woman used to do the backbreaking job of bathing and preparing the children for school. She would wake up at 5 am to start the preparations.

Describing the difficulties of fitting into Ndanu’s shoes, Misuvu says: “I tried for a few days to wake up at 5 am in the morning to prepare breakfast for the children but it was too much for me.

Often exhaustion and my poor eyesight

Strength of a

Woman

September 27, 2010

When you are a mother, you are never really alone in your thoughts. A mother always has to think twice, once for herself and once for her child.

— Sophia Loren

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got the better of me and I ended up spilling the food,” explains Misuvu.

She says before “things grounded to a halt” her married daughter, Ms Martha Yuma whose homestead is in the neighbourhood came to her aid by offering her teenage daughter who now assists in preparing the children for school in the morning.

“Although I do not know for how long I will stay with Martha’s daughter, her coming into the scene was a big relief as I was almost breaking down.

If anyone had a hand in my daughterin-law’s death, then he remains cursed forever,” says the distraught grandmother.

Remarriage This experience leaves Misivu with only one option, she recommends that her son remarries for her grandchildren to have a mother figure around them.

“Ndanu pampered me. She virtually did everything for me. She washed my clothes, gave me good food and bathed me. I pray that God will give us a perfect replacement soon,” says the granny.

The grandmother has benefited a lot from the generosity of her neighbours who have been bringing firewood and water. However, she is worried that they might soon develop generosity fatigue.

The children’s father, Titus Yuma says his wife’s unexpected death dealt him a big blow and left him completely disoriented.

“Sincerely, I fear for my children as my aging mother does not have the capacity to give them maximum care. Even if she tried, she cannot be the mother whose absence they have started experiencing,” says Yuma.

Describing his wife as a loving, caring mother and wife, Yuma doubts whether the house maid he is planning to hire will give his children the desired comfort as he concentrates on his work in Mombasa.

Seeking justice Lamenting the loss of his wife due to the alleged negligence of the doctor at Mwingi Hospital, Yuma says: “I will not rest until justice is done.”

With no one to take care of the family livestock, Yuma has had to move the animals to his brother’s homestead as he contemplates the next course of action.

“When my wife was alive she made sure that all our cattle and goats received good care but my aging mother cannot take up that responsibility,” he laments.

For the sake of his children, Yuma is not in a hurry to remarry. “I am telling you these days to get a good woman who will be a good mother to the children left behind by another woman is difficult. For now, my priority is how to make my children as comfortable as possible,” he says.

Yuma has launched a complaint with the Kenya Medical Practitioners and Dentist Board (KMPDB) over the death of his wife due to alleged negligence on

During happier times Titus Yuma, with his wife Mary Ndanu who died in a botched caesarian section.

— Picture: Musembi Nzengu the part of the doctor who operated on her.

The KMPDB officials led by Dr Dominic Mburu who visited the hospital shortly after the death on a fact finding mission recommended the interdiction of the errant doctor as an autopsy the carried on the body of the deceased revealed that she died of excessive bleeding.

A report to the KMPDB headquarters by the Medical superintend in-charge of the Mwingi District Hospital Dr Daisy Ruto indicates that the doctor was “drunk and aggressive” when he went into the theatre.

But in his defence Odour wrote to the Board claiming that the deceased was taken to the hospital too ill but efforts to save her were futile.

However, the management of the Mwingi District Hospital where Ndanu died blames Odour for her death.

A letter to the Chairman of the Medical Practitioners and Dentist Board Prof. George Magoha from the Mwingi District Hospital’s Medical superintendent, Dr Daisy Ruto says the doctor displayed professional

negligence in the handling of the patient.

Giving a report on the maternal death case that happened in the wee hours of last June 24, Ruto alludes to various mistakes of omission and commission by the doctor contributing to the death of the young mother.

She observes that although the doctor in question had reviewed the patient when she arrived in the hospital at midnight on June 23 and recommended an operation, he went missing soon thereafter.

At 1 am, Ruto wrote, when the patient was wheeled to theatre, everybody was ready except the missing doctor. The driver who was sent to pick him could not find him.

She further claims that the medical officer could neither be reached on phone.

The medical superintendent adds that the doctor whom by the time we went to press was serving interdiction was later to come to the theatre at 1.45 am “drunk and aggressive.”

In the report that Ruto wrote to the board, only hours after Ndanu’s death, indicates that even after an operation

“I am telling you these days to get a good woman who will be a good mother to the children left behind by another woman is difficult.”

— Titus Yuma

to remove a still born child, the doctor unscrubbed before closing the abdomen and left the theatre at 3.45 am.

She reports that he only came back at 4.15 am to suture the abdominal wall but efforts to resuscitate the patient failed and she (Ruto) was informed that although the doctor went back, the patient succumbed to her death.

Ruto further concludes that the patient died of haemorrhagic shock and that there were delays by the doctor when he was being looked for.

Doctor’s negligence The medical superintendent adds that he (doctor) exhibited professional negligence by walking away without closing the abdomen and without assisting in the resuscitation.

She points out in her report that the morning after the death of the patient all the Mwingi District Hospital staff converged at her office to protest the doctor’s conduct.

However in his defence, Odour responds Ruto’s report by indicating that the patient was brought to the hospital too weak to be assisted.

In a report to the KMPDB of which we have a copy in our possession, Odour says, in his opinion the cause of death could have been excessive bleeding prior to admission which led to severe anaemia and cardiovascular compromise.

He concludes: “Therefore, the patient was a poor anaesthetic candidate but attempts had to be made to save the life of the mother and baby.”

Motherhood is priced, of God, at price no man may dare to lessen or misunderstand.

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— Helen Hunt Jackson

September 27, 2010

Women camp in hospitals to access skilled birth care

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ary Mukami from Kamacharia village in Mathioya opted to stay at the Murang’a District Hospital waiting bay for three days before admission for fearing of being attended to by unqualified personnel in rural health centres.

Mukami, like many women who reside in the rural areas, would seek professional services at the established facility where she is sure of getting better treatment.

Queues “I travelled to Murang’a town with two days to the due date. I had no option since I have no relatives in the town. I joined a queue of other women from the rural areas in the corridors of the hospital,” explains Mukami.

The women normally camp at the entrance of the hospital during the day as the waiting bay is filled up with patients seeking out patient services only to return after 7 pm.

Mukami was only admitted into the maternity wing once she developed labour pains.

Mary Mumbi, a 40-year-old mother remembers with nostalgia how between 1990 and 2000 many women feared giving birth in public hospitals due

to the unprofessional conduct of health care attendants. During that period most mothers preferred private facilities.

“Today things are better that women have a lot of confidence with public facilities owing to 24 hours administration by qualified personnel,” explains Mumbi.

An official of the National Council of Women in Kenya, Ms Jane Kamwaga, lauds the Government for giving rural health facilities a face lift that has lead to improved health care of women and their children.

“Major strides have been made although not 100 percent in health care as maternal health issues continue to affect women in Kenya,” said the official.

Despite the establishment of many maternity units in health centres within Murang’a District, many mothers have a passionate need for quality care for themselves and their babies.

They would rather spend the night in the open at the district hospital waiting bay once they realise the due date is fast approaching.

Major maternal health challenges in the region include services of qualified, long distances between health facilities and perennial shortage of family planning pills among others.

However, investigations established that a number of women who do not attend antenatal clinics cite the high cost of travelling far in search of the services.

Although poverty plays a great role in barring a number of women from seeking the service, mobile clinics have been established at the location level after it was established that some women go to hospital only when they have developed labour pains.

The Medical officer in charge of Health at the hospital, Dr Ephantus Maree says that health education has been taken to rural areas where they are educating mothers on the importance of ante-natal and post-natal clinics.

Safe delivery The Ministry of Medical Services in conjunction with donor agencies have put up spirited campaign to ensure safe delivery in public and private facilities.

Maree says once a maternal death occurs, investigations are carried out to help establish the cause.

This year, he said, only a single incident occurred when a mother died leaving behind a child under her husband’s care.

“In case such a thing happens, heads must roll as the administration of the

Strength of a

Woman

By Ryan Mathenge health facility must help establish the cause,” explained the MOH. The hospital’s committee places emphasis on carrying out an audit detailing what could have caused death of a mother or child.

The audit investigates on all factors from medical complication to negligence on part of the medics attending her.

Action is taken immediately to have the problems rectified for future.

In the rural areas, under the economic stimulus programme, the government has identified various dispensaries and health centres that would benefit and have maternity wards constructed.

Research has shown that many women fail to attend clinics owing to long distances and the increased poverty in the rural areas with many failing to afford fares.

Those travelling long distances also fail to have money to book hotel rooms for accommodation and instead camp on the health facilities benches.

Murang’a District Hospital which is the main referral unit in the county is an example where expectant women whose days to deliver are due and owing to long distances camp in the benches at night as they have no relatives within the hospital’s vicinity.

Kenya engages reverse gear on maternal health CONTINUED from PAGE 3

while progress has been recorded in various countries, the situation in subSaharan Africa is still bad.

The MDGs are international developmental targets that 189 countries set to meet by 2015. These targets were agreed upon in 2000 during a UN Millennium Summit.

One of the targets that sub-Saharan Africa is grappling with is reducing the rate of maternal deaths. At the global scale, the UN recently released figures on maternal death trends, showing the number of women dying of pregnancy related causes is going down.

However, the regional director for Eastern and Southern Africa, UNICEF, Mr Elhadj Amadou Gueye Sy says, while progress is notable at the global scale the figures mask disparities between countries and within nations.

“There are disparities between the rich and poor and those living in urban areas and those in the rural areas. In countries in sub-Saharan Africa the situation is markedly different where the poor still can not access health services, nutrition, clean water and good sanitation,” explains Sy. A reproductive health expert, Dr Joachim Osur says while for women in

urban areas the thought of giving birth in hospital is obvious, for those in rural areas and peri-urban areas the situation is different.

“When you go down the economic scale, there are women in this country who have never had the luxury of being attended to by a gynaecologist or midwife. Most of these women deliver at home or in ill-equipped clinics putting their lives in danger,” explains Osur.

He says ongoing reviews in the region show goal five of reducing maternal deaths has not registered any significant improvement for the last few years.

Skilled attendants According to the UN maternal trends figures, in countries that have registered success, very simple measures have been employed. Certain countries have reduced number of maternal deaths by concentrating on female education to pass the message on the importance of delivering with skilled help. Countries are also training more health workers and deploying them in all health centres. They are also ensuring that health facilities are closer to the people, where they do not have to walk or travel for long distances to

access help.

In certain parts of Kenya, women who are in labour die as they try to access hospitals located far from their homes.

Eastern Asia has experienced reduction in maternal deaths due to increased contraceptive prevalence rate which currently stands at 86 percent.

That of Sub-Saharan Africa is only at 22 percent.

Osur says the debacle in Kenya’s maternal deaths prevalence is occasioned by the fact that there is a lack of committed funding directed to reproductive health.

“Kenya cannot survive without external help. We are almost 100 percent reliant on international donors for funding towards maternal health. If one wants good services they must pay for this which makes it inaccessible for the poor,” he says.

When one leaves Nairobi and other urban areas, health workers are scarce and health facilities are ill-equipped and often lack in supplies.

Osur also laments the fact that community education is lacking in most rural areas. The situation in Kenya has deteriorated from what it was in the early 1990s when there

was a government campaign on family planning. Due to lack of funding, such endeavours have dramatically reduced.

To achieve the goal on improving maternal health, governments will need to focus on the poor, people such as Ambasa. This will be done through provision of primary health care to reach those most at risk, those living below the poverty line, women in far flung areas.

New policies Currently, Kenya’s initiatives have included introduction of policies on task shifting among health care providers that involve transferring responsibilities to lower cadre staff such as nurses and clinical officers.

Community midwives who are mainly retired have been brought on board, reoriented and provided with delivery sets to offer skilled attendance during delivery at community-level and to provide health messages. Ward nurses and clinical officers have been allowed to offer post abortion care.

Whether this will translate to reduced numbers of maternal deaths remains to be seen, in the meantime, sub-Saharan Africa and Kenya remains a dangerous place for pregnant women.

Strength of a

Woman

September 27, 2010

You cannot have maternal health without reproductive health. And reproductive health includes contraception and family planning.

— Hillary Clinton

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The pain of spontaneous miscarriage

By Valerie Aseto and Faith Muiruri

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he desolately stares blankly into the sky, her eyes filled with tears of bitterness. For almost ten years now, her life has been that of wait and see. As each day passes so does her expectation that her efforts will eventually bear fruit.

At 28, Sarah Khatenje has suffered three miscarriages. Her dream to cradle to her own bundle of joy has now become a nightmare. Anytime she conceives, she ends up losing the pregnancy prematurely.

“I don’t know why I cannot carry my pregnancy to full term. Anytime I conceive I lose the pregnancy mid way and the furthest I have gone is six months,” she laments, tears welling in her eyes as she recalls the painful episodes.

In what she describes as a very weird situation, Khatenje who has been married for ten years claims efforts to seek medical explanations have not borne any fruit.

“I have been in and out of hospital in search of a remedy but the situation remains the same despite assurances from doctors,” she says.

Complication Khatenje first got heavy with child in 2002 but the pregnancy only lasted for six months. “I developed complications when I was only three months gone and was admitted at the Kenyatta National Hospital (KNH) for another three months where I lost my baby,” she explains.

“I only heard the doctor say my cervix had dilated (nyungu ya mtoto imetoka) and that cold had entered my womb, therefore, I could not carry the pregnancy to full term,” she narrates.

Together with her husband, they sought an explanation from the hospital but no answer was forthcoming.

Undeterred, Khatenje conceived again in 2006. This time, she went to St Mary’s Mission Hospital in Lang’ata where she attended the pre-natal clinic.

All was well and doctors assured her that the baby was in good condition.

At six months, Khatenje started experiencing a lot of pain. She sought

help at the hospital where and was admitted for three months but unfortunately she lost the second baby.

“I felt pain and on the numerous occasions I sought explanations from the doctor, nothing tangible was forthcoming. I did not know what to do because I had been to different hospitals but all they did was to take me round in circles and no one was willing to offer candid explanations or still advise me on what could be done to salvage my situation, ”she adds.

Alternative medicine Khatenje then resorted to traditional medicine. A friend introduced her to a midwife in Eastleigh Estate who offered her some concoction to clean her fallopian tube which according to the traditional birth attendant was ‘dirty’.

Two years after the treatment she was pregnant again. All was well but come the eighth month, she developed premature labour pains and went to Kenyatta Hospital where she delivered a baby boy. The baby was underweight and had to be taken to the incubator. He stayed there for seven days before he died.

“This traumatised me and upto now I have never understood why my baby died because when I gave birth, I saw another woman who had a smaller baby than mine but hers survived while mine died,” she explains amid tears.

Khatenje is among thousands of women who lose their pregnancies through causes they hardly understand about.

Spontaneous abortion Miscarriage is a medical condition in which a woman loses the pregnancy before the baby is viable. It mainly occurs within 22 weeks and 28 weeks of the pregnancy. According to Dr Gathari Ndirangu, a technical advisor on reproductive health, Khatenje’s situation is very rare and is widely referred to as spontaneous abortion.

It mainly occurs to women with pre-

Sarah Khatenje longs to be a mother but has suffered three miscarriages and has never been given a proper explanation. Below: Dr Gathari Ndirangu, a technical advisor on reproductive health.

— Pictures: Valerie Aseto. existing medical conditions such as hypertension, high blood pressure, hepatitis B, viral infections, diabetes and malaria. Other causes include cervical incompetence, which means that the cervix is not able to close in order to hold the foetus firmly.

Miscarriage can also occur in rhesus negative women who react by forming anti bodies which attack the pregnancy.

The doctor says that three to five people are rhesus negative, a condition which is likely to endanger the pregnancy.

“I don’t know why I cannot carry my pregnancy to full term.

— Sarah Khatenje

According to the doctor, women who have multiple pregnancies are also likely to have a miscarriage.

However, he says that some women who have miscarriages can be treated surgically to enable them carry the pregnancy to full term.

He further points out that all expectant women are always advised to seek antenatal care to detect complications at the initial stages of development.

“Pregnant women are always advised to go for pre-conception care as early as three weeks to avert such occurrences,” he says.

Ndirangu says globally up to 30 percent of pregnancies are lost as a result of ignorance and, therefore, the correct precaution is that all expectant women should attend antenatal clinic.

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The states are not free, under the guise of protecting maternal health or potential life, to intimidate women into continuing pregnancies.

— Harry A. Blackmun

September 27, 2010

With the right support, maternal deaths can be prevented

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regnancy and the subsequent delivery of a child is normally a joyous occasion. However, pregnancy, childbirth and the related complications are the most common cause of death and disability in women of childbearing age between15 to 49 years.

In Kenya, the most common cause of admission into hospital for females is pregnancy, childbirth and the ensuing complications.

In attempting to understand maternal mortality, Venter Mwongera spoke to Dr Nancy Kidula, an Obstetrician/Gynaecologist who works with the World Health Organisation as a National Professional Officer in charge of Making Pregnancy Safer Unit.

Question: What is maternal mortality?

Kidula: Maternal mortality is described as the death of a woman while pregnant or within 42 days of termination of pregnancy or delivery from any cause related to or worsened by the pregnancy or its management.

Q: What can cause death of the mother during pregnancy and childbirth?

A: In Kenya, most deaths of mothers during pregnancy and childbirth are due to severe bleeding. After delivery, a woman can die within two hours if she bleeds excessively. Other causes include high blood pressure (hypertensive disease) in pregnancy; severe infection or sepsis especially after delivery; abortion related complications and obstructed labour. Indirect causes of maternal mortality include HIV/Aids, Malaria and Anaemia (lack of enough blood).

Q: How frequently do mothers die?

A: Worldwide, a woman dies every minute from pregnancy related complications. In Kenya about 21 women die per day (approximately one every hour) as a result of pregnancy and childbirth. That is equivalent to a Nissan matatu crashing every day with pregnant women on board and all of them dying!

Q: Can someone know if they will die from pregnancy?

A: Actually one cannot predict if it is them who will die as a result of the pregnancy or during childbirth.

Q: How then can one prevent this unfortunate event from happening?

A: Prevention of death from pregnancy and childbirth is quite simple. Expectant women need to attend the antenatal clinic starting early before four months of pregnancy and make sure they attend clinic at least four times during pregnancy and as advised by the health worker. At this time, the mother will be checked and any problems diagnosed will be treated early enough.

Several tests will be taken and preventive measures and drugs provided.The woman will also be assisted to develop an individualised birth plan and trained on how to recognise danger signs during pregnancy.

It is also recommended that for the safety of the mother and baby, delivery should take place in a health

Strength of a

Woman

Lucky are those men who have families to support them

By Ajanga Khayesi

S

Dr Nancy Kidula, Obstetrician/Gynaecologist with the World Health Organization as the National Professional Officer in charge of Making Pregnancy Safer Unit.

— Picture: Venter Mwongera.

facility and under the care of a trained professional.

Delivery by untrained personnel, even though for some it may appear cheaper and more convenient, has been associated with more deaths and disability.

After delivery, the mother and baby must be reviewed by a skilled health professional within 48 hours of delivery since most deaths occur at this time. Any complications detected will be treated on time.

Q: Do you recommend family planning? And what role does it play in maternal health?

A: Family planning saves life. For the safety of mother and baby, couples must plan the number of children they will have, when to start a family, how to space the pregnancies and when to stop child bearing. This will prevent the common problem of having children too early (before 18 years), too close together. Recommended spacing is at least two years apart, too many — more than four pregnancies — is risky for the mother’s health. Having children too late in life — above 35 years of age — is also risky for the mother. All these factors have been shown to increase the risk of death for both the mother and baby.

If women of child-bearing age and girls are to survive, then they have to delay pregnancy through use of contraceptives.

Research indicates that if adolescents delay pregnancy until after their 18th birthday, maternal mortality would be reduced significantly.

Q: What of family support to the pregnant mother?

A: Spouses, families and communities must support the pregnant women by ensuring that they have adequate food, they rest enough, they have the funds and transportation to get them to the hospital in case of emergency, and they have the psychological support they need during and after pregnancy.

Everyone can contribute to this. Let us not allow women to continue to die while giving life!

ix months ago, Monicah Akinyi walked into Nyagoro Health Centre in Homa Bay District, hoping to deliver and carry home a healthy baby.

Unfortunately, Akinyi had developed complications while at home and decided to seek medical attention.

“Trouble started when she discharged watery fluid for 48 hours,” says Florence Atieno, her sister-in-law. The family took her to the health centre where she had been going for ante-natal clinic check ups.

Due to the poor facilities, the health centre maternity personnel referred Akinyi to Homa Bay District Hospital where she went into labour for an hour before delivering her sixth child Master Joseph Obama.

After the delivery, Atieno continued to bleed profusely for about one hour.

“Since it was on a weekend, there was no doctor at the hospital to attend to her.

Only trainee nurses were available. Although the trainees tried in vain to save Akinyi, she succumbed to death while still on the hospital’s maternity bed,” explains Atieno.

Atieno says inadequate blood transfusion and negligence by senior medical personnel at the hospital contributed to her sister’s passing.

The healthy baby named Obama was placed in an incubator for 13 days before being discharged and handed over to his father, Mr Tom Ochieng, a school teacher at Kochia village, in Homa Bay District.

The father being a man could not be entrusted with the child.

Atieno says: “Obama needed proper attention and motherly care of which the father could not provide. We discussed as family members and I was entrusted the care of the boy by virtue of being the eldest daughter in the family.”

She adds: “Akinyi’s eldest daughter Beril is a student in high school while the other two girls and a boy attend different primary schools at Homa Bay.” Coming to terms with Akinyi’s sudden loss has been a bone in the flesh for the family at large, especially to the husband who had to adjust to household chores and bring up the orphaned children.

The second last born girl Christine Awino, three years old, joined Atieno’s family alongside Obama.

Atieno is a teacher in Kisumu town.

She was widowed nine years ago and has a daughter, Jael Anyango, who is a mass communication student.

Customarily, some family members opposed the fact that Atieno being a young widow might fall into the inheritance prey while caring for Obama and would likely to bring an abomination to the baby.

But Atieno, a staunch SDA follower stood by her religious beliefs and the baby is currently under her care.

Strength of a

Woman

A baby is something you carry inside you for nine months, in your arms for three years and in your heart till the day you die.

September 27, 2010

— Mary Mason

Sharing of beds is the norm at Naivasha Hospital

9

BY George Murage

Patients at the Naivasha District Hospital share beds in the maternity wing. It is not uncommon to find up to three patients sharing a bed in the hospital that records at least 18 deliveries daily.

— Picture: George Murage.

I

t is a cold morning, long queues mark the hospital’s out patient section as a lone worker tries to clean up what appears to be blood stains on the floor.

For the last one hour, an ailing child overdressed to beat the biting cold cries and jerks uncontrollably despite the mother’s attempts to comfort him.

Nearby, an elderly man coughs continuously spitting a yellowish substance on the hospital floor annoying the cleaner.

As the cries and coughs gets worse, so does the queue as more patients, mainly pregnant women arrive at the Naivasha District Hospital in need of medical assistance.

In one of the examination rooms, a lone and tired clinical officer examines the never ending patients who are suffering from various ailments.

And out of the blue, in comes a blaring Nissan matatu carrying what appears to be accident victims.

With lights on, the driver hoots wildly as he pulls next to the examination room where the clinical officer was busy examining a man with a gaping wound on his hand.

And with the entrance, the crying minor, the coughing granny and the pregnant women are forgotten as all attention moves to the new arrivals.

With only two examinations rooms, the accident victims overwhelm the staff and soon some are lying on the floor groaning in pain.

With no gloves, a watchman and a member of the public assist a bleeding man onto rusty stretcher that looks like it might give in anytime.

This goes on for hours before attention is reverted to a pregnant mother whose time seems to have come too soon.

She is rushed to the maternity wing

groaning on an equally ageing wheel chair. In the ward, she is met by a sea of humanity as up to three women, some who have just given birth share a bed.

For some time she remains glued on the wheelchair as the few nurses try to make efforts to have her admitted in the delivery wing where two women are already being attended to.

Already there is another queue of a group of women sweating and panting as they wait to enter the delivery room.

Staff shortage This is the norm for Naivasha District Hospital where the high number of patients mainly in the maternity wing against overworked and understaffed nurses is the norm of the day.

Services at the hospital maternity wing have been over stretched to the limit with up to three patients sharing a single bed.

The situation has been worsened by an acute shortage of staff with sometimes only two nurses manning the wing mainly at night.

Following the move, patients have called for Government assistance. There are fears that things could get out hand if the situation is not arrested.

And for Vicky Nafula, Naivasha District Hospital maternity wing has two faces just like the coin.

A mother of three, she sees the wing as the only resort for poor women seeking to give birth and have to endure suffering at the same time.

The flower farm worker has delivered all her three children in the hospital with the last child born three weeks ago.

“As a flower farm worker, I cannot afford to go to private hospitals and my only hope is Naivasha District Hospital where the charges are more affordable,” she reiterates.

Nafula says that of the three times she has delivered in the hospital, sharing of beds has irked her most. Depending on the number of patients in the ward, she says, as many as three women some with their newly born babies are forced to share a bed.

“The biggest worry among mothers is the fear that the newly born might get infected by their neighbours,” Nafula explains of the tribulations.

“Some of the patients are very dirty, arrogant and sometimes insensitive,” she recalls of her frustrations.

Nafula says that due to the high number of patients against overworked and under staffed nurses, many patients go for long hours with labour pains before they are attended to.

“I have seen some women deliver by themselves on maternity beds mainly at night as the only nurses available are assisting other women give birth in the delivery room,” says Nafula.

According to Monica Wangui Nguro, a visit to check out on how her sister-inlaw was fairing after giving birth early last year left her traumatised.

“She had given birth through

“I have seen some women deliver by themselves on maternity beds mainly at night as the only nurses available are assisting other women give birth in the delivery room.”

— Vicky Nafula

caesarean section and the most worrying thing was that she had not been fully attended to and was still bleeding,” says Wangui.

She says after hours of seeking assistance from the nurses the family was forced to transfer her to a private hospital.

Wangui appeals to the Ministry of Health to fully equip and bring in more personnel to the hospital that serves thousands of people with the bulk coming from the flower farms.

Confirming the problems, the officer in charge Dr Joseph Mburu says that though the maternity wing capacity is 24 beds, they are handling over 70 cases.

He says that the facility is the busiest in the district handling around 18 normal deliveries and at least three caesareans per day.

“It is true our maternity wing is congested but we are doing everything possible to make sure that our patients are comfortable and get the right treatment,” explains Mburu.

The doctor attributes the high number of patients to flower farms workers in the town, majority of whom rely on the hospital.

Of the 57 flower farms in the town, only three — Sher Karuturi, Oserian and Homegrown — have their own health centres than can handle maternity cases. “We also get patients from Kinangop in Central Province and parts of Narok further stretching our services,” he says.

The doctor says the hospital needs at least 100 more nurses to cope with the high number of patients in various departments.

He is, however, optimistic that the congestion problem could be solved once a women’s wing that is been sponsored by flower farms is opened at the end of the year.

10

A mother’s joy begins when new life is stirring inside... when a tiny heartbeat is heard for the very first time, and a playful kick reminds her that she is never alone. — Author Unknown

September 27, 2010

Strength of a

Woman

Putting professionals Insurance cover for cervical cancer at the centre stage

A

new online project has been launched by the University of Oxford that will enlist the expertise of 10,000 midwives, nurses and doctors across Africa, Asia, Latin America and the Middle East to identify ways of preventing unnecessary maternal deaths.

‘Global Voices for Maternal Health’ is the first international project to make use of crowd-sourcing technology in the public health sector on such a scale.

Dr Stephen Kennedy, who is jointly leading the project at the Nuffield Department of Obstetrics and Gynaecology, University of Oxford, said: “The project will give new weight and force to the views of people who are actually delivering medical care, especially in developing countries. It will provide them, for the first time, with a powerful voice to set out exactly what needs to be done in their locale to reduce the number of maternal deaths and influence change on a global scale.

“Global Voices for Maternal Health will put healthcare professionals at the centre-stage, harnessing their combined experience and insight to kick-start a revolution in the provision of evidence based maternal healthcare where it is most needed,” he adds.

The Oxford team, with the support of the International Federation of

Gynaecology and Obstetrics (FIGO) and the International Confederation of Midwives (ICM), aims to ask 10,000 healthcare professionals (the crowd) to complete an online survey about their local maternity services and the difficulties they face. The results will provide the first global picture of maternal healthcare services and the extent to which evidencebased interventions are being adopted.

A crowd-sourcing discussion forum will allow those delivering the services to drive the search for solutions to all the preventable maternal deaths that occur every year around the world.

Kennedy explains: “We hope to see a host of inventive and promising solutions put forward. The best ideas will be determined by the crowd, with prizes awarded for the best contributions.”

The UN Millennium Development Goal (MDG) of reducing the maternal mortality ratio by three quarters between 1990 and 2015is acknowledged to be the area of least progress amongst all the MDGs, as there are still between 340,000 and 500,000 maternal deaths annually worldwide, according to the latest estimates.

Results of the survey of maternity healthcare provision and crowd-sourcing discussion forum will be made available online shortly after they come to a close on October 10, 2010. www.globalvoices.org.uk

Empowering the TBAs

E

By Abjata Khalif

ven though women in northern Kenya tend to favour traditional birth attendants (TBAs) when it comes to time to put to bed, efforts are being made to create awareness on why they should seek skilled birth attendants.

Efforts to ensure safe delivery of children has been complimented by various training and outreach education being conducted in rural areas. The training sessions are expected to boost the expertise and knowledge of the TBAs. The initiative led by Garissa based UNICEF sub-office has so far trained 140 TBAs in the past three years. Through community workers trained by UNICEF, the attendants were trained on safe methods and handling of delivery in remote areas where they offer their services.

According to Dr Mohammed Elmi of UNICEF Garissa, the TBAs are trained on proper methods of delivery and advised on the steps to take in making a referral to a hospital when they encounter complicated

cases. The attendants are taught early diagnosis of complicated such as twin delivery and history of miscarriages so that they can make timely decisions in referring the women to hospital for proper medical attention.

Elmi says TBAs have in the past been taught on health issues with regard to the mother and child among others that include nutrition and family planning. This will enable them impart the knowledge to the mother during the post-natal period.

The TBAs also receive education on safety. They are sensitised on the importance of using gloves during delivery. They also learn how to sterilise instruments used to cut the umbilical cord so to minimise the risk of spreading HIV/Aids from the attendant to the mother and the mother to the baby.

While acknowledging the role played by attendants, Elmi says the traditional method of delivery is in conflict with modern science and needs to be reconciled with training the TBA on modern techniques of delivery.

A

By Jane Mugambi

n insurance policy has been introduced the package to cater for serious and terminal cases that other insurance companies fear to getting involved in. An insurance company has introduced a policy for women to help them get treatment and medication for cervical cancer.

“Women should take the advantage of getting this cover which caters for all terminal cases like cervical cancer,” said Mr Augustus King’ori.

Speaking after opening the APA Embu branch office, King’ori said that the Femina package will enable women get insurance cover for as little as KSh1,000 covering to up to KSh250,000 while KSh1,950 for KSh500,000 yearly.

APA gives from KSh250,000 to KSh500,000 for an insured woman who has been diagnosed with cervical cancer that is normally treatable at an early stage.

The package varies with the age bracket where women as young as 20-29 years will get insured after paying KSh1,000 for the cover, 30-39 will pay KSh1,550 and those aged 40 and above will pay KSh2,000 per annum.

However, he said that they cannot insure cervical cancer patients who are already undergoing treatment.

King’ori said they have introduced the plan in Kyeni, Embu District but have hoped to extend the plan to other parts of the country.

Ring-fencing protects health sector

E

By DUNCAN MBOYA

nsuring that even the poorest and most marginalized women can freely decide the timing and spacing of their pregnancies, requires targeted policies and adequately funded interventions.

Yet financial resources for family planning services and supplies have not kept pace with demand in most sub-Saharan Africa countries. To help save the situation, it has been found necessary to put a tab on budgets so certain quarters do not suffer.

Generally budget allocations are often affected by demand for services of a particular sector. However, policies are now being put in place to protect certain sectors from fluctuating allocations.

The ‘ring-fencing’ policy on the budget expenditure on health projects has helped improve maternal health. Ring fencing is the case whereby the agreed allocations to a particular sector is never reduced no matter what happened to the revenue.

Improvement While other sectors may experience cuts in budgets, Kenya’s ‘ring-fencing’ protects the health, education and poverty sectors from such cuts. The proportion of births attended by skilled health personnel increased from 42 percent in 2003 to 56 percent by 2007.

Aid for family planning as a proportion of total aid to health declined sharply between 2000 and 2008, from 8.2 per cent to 3.2 per cent.

Aid to reproductive health services has fluctuated between 8.1 per cent and 8.5 per cent. External funding for family planning actually declined during the first few years of this decade and has not yet returned to its 2000 level.

Although the poor state of the health infrastructure in the country contributes directly to the observed poor maternal health outcomes addressing the long-standing cultural, social, political and economic factors that have contributed to precarious maternal health in most countries is needed.

Inadequate skilled manpower in state hospitals and primary health centres, poor motivation system, inadequate funding, poor management of health sector resources, weak transparency and accountability framework in the sector also need to be addressed in good time.

Strength of a

Woman

Making a decision to have a child — it’s momentous. It is to decide forever to have your heart go walking around outside your body.

September 27, 2010

— Elizabeth Stone

11

Mothers find hope in make shift incubator

W

omen having children in the slums are usually worried if they happen to have premature births.

Living far from medical facilities that would enable their babies survive, majority of them are often left clinging to memories of their pregnancies but with no child to hold.

However, one woman’s innovation in the sprawling slums of Mathare is bringing hope to women who have babies before their pregnancies get to full term. Her makeshift incubator is behind the survival of several babies born prematurely in the sprawling Mathare slums.

Elizabeth Alice Atieno, a Traditional Birth Attendant (TBA) is the brain behind the innovative but simple incubator that has saved the lives of newborns at the informal settlement.

The homemade medical ‘machine’ entails a piece of wood, a tattered lesso (cloth) and an energy saving bulb.

Atieno whose one roomed dingy house doubles as the delivery room in the slum, says the makeshift incubator has saved many lives. The new born is wrapped in cloths, which are tattered for warmth leaving a portion of her face that includes the nose and eyes.

“I place babies on the makeshift incubator below a lit energy saving bulb to generate heat for their warmth,” she says.

What happens when there is a power blackout or no electricity? Atieno even gets more innovative because for her the ultimate goal is to save the babies.

“I put warm water in two locally made water bags and place them on both sides of the baby when there is no electricity,” she explains.

There are occasions when she has delivered more than one premature baby and the newly-borns have been forced to share the makeshift incubator. Once she even had three pre-mature babies sharing the apparatus.

The seasoned midwife who has helped deliver several children in Mathare says necessity is the mother of invention.

Premature births There are premature babies who have passed away at birth late at night or early in the morning for lack of modern incubators.

“Increasing numbers of women are going into labour before their due date some as early as three months before time,” Atieno says.

Most pregnancies last about 40 weeks, while premature births take place more than three weeks before the due date.

Premature birth gives a baby less time to develop and mature in the womb causing increased risks of medical and developmental problems.

Medical journals concur that difficulty in breathing and bleeding in the brain are among the risks a child born early may suffer.

The TBA says the makeshift incubator has also helped newborns whose mothers pass away during delivery to survive.

“There is yet to be a case of a baby who has been put in the incubator and failed to survive even without the presence of the mother,” explains Atieno.

She says the rate of delivery in the slums is high arguing even girls as young as 14 years benefit from her expertise.

Atieno says the recent baby boom in the slum which she attributes to effects of the post election chaos, may force her to make more incubators.

By FRANK OLERO “I have never been this engaged since I learnt midwifery through apprenticeship over 20 years ago,” she says.

Tools of trade The midwife who uses hot water, a string and razor blade that has been boiled in hot water for sterilisation says placentas of the newborns are buried on grounds within the slums.

“We lack latrines where placentas can be disposed so we opt to have them buried to ward of their pungent smell,” explains the TBA. Elizabeth Otieno Since they do not demonstrates how have facilities that can she makes the be found in conventional makeshift incubators. health facilities, they Below: A child born spread cartons and prematurely in the polythene on their incubator. earthen floors where — Pictures: AWC women in labour women Correspondent lie before delivery begins.

“The carton provides them with a comfortable place to lie on while the polythene/nylon controls the blood from spreading,” she says adding “we are simple and natural”.

During and after delivery they use hot water to “I get reports of newborns delivered with the aid ward off infections such as pneumonia and colds. of the midwives deep inside the slum. I record about Atieno says they use hot water arguing newborns 10 live births a day,” says Otoyi. delivered using cold water suffer bouts of pneumonia The provincial administrator says several factors after birth. and reasons have made the midwives the darlings of Medical articles at the MayoClinic.com say that the slum dwellers. contractions that occur more than six times each hour “Improper infrastructure deep in the slum prevents to expectant women are among the symptoms of early women in labour from accessing the main road to go birth. to mainstream hospitals,” says Otoyi.

Other symptoms of premature birth include low, The administrator says insecurity in the area dull backache, pelvic pressure or pain, diarrhoea, remains an issue particularly at night reiterating that vaginal spotting or bleeding and watery frequent poverty impacts negatively on the lives of residents. vaginal discharges.

“Some people fear to walk within the slum at night Most TBAs in Mathare double as herbalists who and carrying a woman in labour on a stretcher could learnt the trade through apprenticeship — some be worse,” explains Otoyi. may be self-taught but are not certified or licensed.

Statistics from the Kenya Demographic Health Even though the women deliver through TBAs Survey (KDHS) show that approximately 414 maternal they still have to report the births to the provincial deaths occur per 1,000 live births. The figures further administration, in this case the chiefs. Mathare/ show that there is an infant mortality rate of 77.2 per Huruma location, Central Division chief Mr Jonathan 1,000 live births country wide.

Otoyi records an average of 10 births a day in the Atieno, however, seldom smiles to the bank area. following payments from parents whose babies benefit from her innovation.

The people do not have money to pay and when she asks for some kind of payment she ends up creating enemies. She treats her work as a calling and not an income generating activity. “People here (Mathare slums) struggle to put food on their tables that charging for my services places us at loggerheads,” Atieno says.

“There are women who pay Sh10 or Sh20 after delivery. We cannot chase them away as we understand the pain of women in the slums,” she explains.

What happens when there is a power blackout or no electricity? Atieno even gets more innovative because for her the ultimate goal is to save the babies.

CONTINUED ON PAGE 13

12

There are three reasons for breast-feeding: the milk is always at the right temperature; it comes in attractive containers; and the cat can’t get it. — Irena Chalmers

September 27, 2010

Strength of a

Woman

The north follows the footsteps of foremothers

By Abjata Khalif

N

orthern Kenya has remained undeveloped ever since Kenya attained independence in 1964. Facilities are far flung and infrastructure remains wanting.

It is this poor infrastructure and ill equipped health facilities that are being blamed for maternal deaths in the region.

No health facilities The situation is compounded by the presence of untrained traditional birth attendants (TBAs) at the village level with no health facilities. The only available assistance in such villages is the intervention and quick help from untrained birth attendant.

The situation has led to poor handling of women in labour pastoralist women are rushed by donkey or other women to homestead of a traditional birth attendant in the remote villages.

Others go to TBAs because that is what they have seen happening in the village around them.

Take the case of Asha Maadow, a mother of five from Wagalla, Wajir West. Maadow has delivered all her five children using the TBAs. She says: “I have delivered my five children here in Wagalla and I have never gone to hospital or a health centre for delivery. I just seek the services of TBAs here and thank God I have delivered the children well and safe.”

Footsteps Asked if she knows the existence of a trained traditional birth attendant and untrained birth attendant, Maadow says women in her village are not able to differentiate between two. The women have used the services of TBAs for hundreds of years and even the younger generation will continue following the footsteps of their foremothers.

Says Asha: “All women in my village seek the services of TBAs. Our mothers inherited this spirit from their mothers following the footsteps of our foremothers who invented it. So we are not worried about our safety. We all know here that women deliver well and if there is a death during delivery then that is God’s will.”

According to Ms Rukiya Maalim, the Executive Director of Girlkind, a

community based organisation based in Wajir, half of maternal deaths in remote villages are caused by lack of skilled attendants and ill equipped dispensaries with a skilled attendant at the village level.

Maalim says: “We have registered a lot of deaths in the remote village levels in Wajir as result of poor handling of women by untrained birth attendants. Some of the attendants are too old and have lost their sight while other are overwhelmed by ageing. Therefore, they cannot work on safe delivery.”

Training However, she is quick to absolve other trained birth attendants from maternal mediocrity and ineptitude.

She says some of those who are trained have done a tremendous job by supplementing Government work of ensuring safe delivery at homes.

Maalim reiterates: “But again we have other gallant TBAs in some areas of Wajir who are really doing good job and they are contributing toward the realisation of Millennium Development Goal five on safe delivery and maternal health.”

The Chairman of Wagalla Centre for Peace and Human Rights, Mr Adan Garad says: “The poor road network and lack of skilled staff as well as health facilities being in remote villages of Wajir has forced most women to seek maternal services from TBAs.” He explains: “They do a great job sometime but again I have witnessed some maternal deaths in their hands.

So the Government and other health organizations should move very fast and train the TBAs on proper care so that they can undertake safe delivery and save life too.”

The chairman of Wagalla Centre further stresses that the Government should set aside some money from the CDF fund in each constituency towards the construction of maternity centres where there no dispensaries or health facilities.

He urges: “I appeal to the Government to set aside some money in the CDF fund towards the building of community maternity wings which will help trained birth attendants undertake their work smoothly and without exposing mothers to dangers.”

Traditional birth attendants in

A woman cuddles her new born baby in North Eastern.

Women in this region hardly have access to skilled health care and have to rely on TBAs for delivery.

— Picture: Abjata Khalif northern Kenya normally charge between KSh200 and KSh800 based on the social status and the distance the attendant has to travel to conduct delivery.

However, it is not only pastoralist women in the remote areas who seek support from both trained and untrained attendants. Even women in urban areas who are living near hospitals and nursing homes still seek services from TBAs. The urban women claim they do not get proper maternal care when they are rushed hospitals and that the nurses are rude to them.

One urban woman, Ms Dansoya Abdi says she has been forced to deal with a TBA who travels from rural areas to her residence near Garissa General Hospital so she can perform safe and peaceful delivery.

Unprofessional staff Abdi says: “For the last 10 years I have not gone to this hospital for delivery. The situation there is horrible for expectant women. Nurses are rude and they beat up women who are heavy with child. Sometimes they leave the women in labour in the delivery room alone for several hours. This has made me and other women opt for peaceful maternal care from traditional attendants.”

She adds: “I hire a traditional birth attendant from Tulla village, about 150 kilometres from Garissa Hospital which less than 400 metres from my house.”

Abdi explains: “The attendant uses

traditional knowledge and I have never complained or encountered problems from her services.”

Abdi says she will pass the spirit of hiring TBAs to her daughters. She will discourage them from the hospitals where they are abused, neglected and allegedly beaten by the nurses at the Garissa General Hospital.

Prenatal care Health officials in northern Kenya, however, paint a different picture.

They say the situation is bad because pregnant women from northern Kenya fail to go for antenatal care.

Data collected by health officials from various remote villages in the province shows that most maternal deaths occur outside health facilities.

In an effort to check rising maternal deaths, health officials have developed three delays model.

The first delay is occasioned by a complex decision making process that includes whether or not to seek care and if so where. This complex decision is done by various players at remote level. Once a decision is reached the second delay comes in terms of lack of transport and easily accessible health facilities.

The third delay is purely institutional in terms of the degree of the emergency preparedness and availability of appropriate staff to undertake safe delivery or make referrals if the woman’s condition is bad.

Strength of a

Woman

September 27, 2010

I know God will not give me anything I can’t handle. I only wish he didn’t trust me so much.

— Mother Theresa.

Boda boda ambulance comes to the rescue

By Oloo Janak

M

ary Atieno started experiencing labour pains just before dawn and by sunrise the situation was threatening to get out of hand. Her home in Kaguria village, South Kabouch Location, Ndhiwa District is far away from major health facilities. The roads from her home to health centres are also very bad.

Like many rural women, Atieno had been sensitised enough to regularly go for ante-natal check-up at the Pala Health Centre, 10 km away. With the onset of labour, Atieno did not think of going to the facility for attention.

“Why don’t you call for an ambulance from Pala Health Centre,” Hellen Omondi, a neighbour suggested to Atieno’s husband who just paced up and down restlessly as they waited for a Nyamrerwa, the village traditional birth attendant on whose advice and support they mostly relied.

Help at hand “Ambulance? Do they have one at Pala?” asked Jacton Onyango in surprise.

To which Omondi replied: “They have boda boda ambulance with a carrier for the patients. It takes complicated cases to Ndhiwa subDistrict Hospital or sometimes to Homa Bay. I have seen it help some women of late.”

With the cell phone number of one of the nurses on her phone, Omondi promptly called. In less than 30 minutes, Atieno was on her way to Pala from where she was later transferred to Ndhiwa sub-District Hospital, 30 km away, where she safely delivered a baby boy.

Atieno and her husband are grateful to the Ministry of Health for introducing the boda boda ambulance service in Pala Division, for a long time one of the most disadvantaged areas in terms of road infrastructure in Ndhiwa Constituency.

“The people here now appreciate the services offered by the ambulance,” says Olga Adhiambo, a lab technologist at Pala Health Centre who is one of the trained riders who regularly use the ambulance to ferry patients to Ndhiwa or Homa Bay.

Positive response Initially, many patients, especially women feared using the motor bike ambulance thinking it was dangerous.

The prospect of a woman at the wheels of the ambulance was even less assuring for a conservative community that has not seen women ride motorcycles. Later another male volunteer was trained to help Adhiambo.

“We found it funny that a motorbike could be used as an ambulance but now we realise how important it has become,

A boda boda ambulance rider at Pala Health Centre in South Kabuoch, Ndhiwa parking the motor cycle after bringing in a patient. This mode of transportation has come as a big relief to area residents who faced challenges accessing health facilities. — Picture: Oloo Janak helping many sick and pregnant women, among other patients reach the hospital in time,” says Pamela Otieno, a resident of Agudo Village in the location. She has been a beneficiary of the ambulance services.

“The area residents respond well.

They call us any time they need the service and we go for the patient. Those we cannot handle here are referred to Ndhiwa sub-District Hospital or Homa Bay District Hospital,” says Adhiambo.

Pala Health Centre is being expanded to provide for maternity and other wards. Work has already begun with funds from the Economic Stimulus Programme.

Pilot The boda boda ambulance service which is an initiative for medical facilities in far flung areas is a novel concept that is just taking root and is being piloted in a few districts. This service is available in Suba District and was three months ago also introduced in Migori District.

“We received two such ambulances which we have given to Ogwedhi and Nyamaraga Health Centres in Suba East and West respectively,” says Josephine Mogaka of Migori District Hospital. The respective health centre committees identified volunteers from their communities who were trained as riders.

Mogaka says the ambulance has improved access to health services especially for the pregnant mothers.

Aided by the mobile telephony that has now spread to nearly all corners of Kenya, the response is quick, helping to deliver women in labour to health facilities within the shortest time possible.

“Some cases are referred to the district hospital and they don’t have to wait until we send an ambulance from here which also attends to other

emergencies within the town and the district,” explains Mogaka.

Ogwedhi Health Centre lies in the farthest corner of the eastern part of the district on its border with Trans Mara District in the Narok County, some 60 km away. Nyamaraga also lies on the extreme western side of the district, neighbouring Tanzania’s Tarime District and is over 50 km away from the district hospital in Migori Town.

Models The boda boda ambulances come in different models. The one at Pala, the “Ranger Ambulance unit” is basically the normal motorbike fitted on the side with a carrier with a metal seat for the patient. But it is reinforced and fairly superior in performance to the ordinary motorcycles.

It uses a hydraulically operated brake on the front wheel, which is superior to drum brakes. The brake fluid reservoir is located on the right handle bar. There are many other features which are elaborately described in the manual.

The patient carrier, mounted on the left side with another wheel to support it for stability, has a top frame for a cover — a transparent canvas — to protect the patient from the hot sun and possibly rain.

However, the ones in Migori are different. A sturdy motorcycle model with heavy metal parts and thick wheels which pull along a carriage similar to the Indian “tuk tuk” that one can see in the streets of Kisumu, Nairobi or other towns.

Without a doubt, this new innovation is helping rural health facilities where it is being piloted to overcome difficulty in transporting patients and improving access to maternal care where delayed access to or lack of adequate health care accounts for more than 50 per cent of deaths.

13

Mothers find hope in make shift incubator CONTINUED from PAGE 11

Atieno says some of the mothers who deliver premature babies are young enough to be her granddaughters that she cannot charge them.

Her innovation has made several minors survive premature birth even though they cannot pass the medical requirements of baby incubators.

High cost hospitals have invested hugely in incubators for prematurely born babies where they are kept on observation by medics.

Flora Okumba who is a midwife in her mid 60s and proud of the several children she helped deliver agrees with Atieno and says poverty affects their trade.

“I helped deliver children who became rich after they moved out of the slums but my life is still the same as I am still wallowing in poverty,” says the TBA. Okumba who learnt the art of delivering babies through apprenticeship at Urima Village, Bondo District says poverty makes life harder for pregnant women in Mathare.

“There are cases of excessive bleeding as most women do not eat properly during their pregnancy following the harsh realities of life in the slum,” Okumba explains.

Expectant women in the slums eat soil or stones for nutrients as the cost of living has surpassed them. The women cannot adhere to the simple prevention measure that medics say could contain premature birth like eating healthy foods and regular prenatal care.

Uncontrolled diseases such as diabetes and high blood pressure increase the risk of premature labour.

The Government recently confessed that widespread poverty levels are among the factors that have pulled back efforts to reduce child deaths by twothirds by 2015.

Others are reducing incidences of hunger and resultant child-proteinenergy malnutrition, widespread cases of malaria, diarrhoea and acute respiratory infections.

Recent statistics from the Government show widespread incidences of malaria, diarrhoea and acute respiratory diseases contribute 25 per cent of reported infant deaths.

The TBAs admit undergoing some of the challenges related to maternal and child deaths during deliveries. Most maternal deaths countrywide are related to complications of unsafe abortions and complications during and after delivery.

“There are mothers who experience excessive flow of blood in the process of delivery while others do not,” says Atieno.

Other complications that arise during child birth are caused by infections, haemorrhage and high blood pressure that contribute deaths of mothers and infants.

14

If women’s rights are not human rights, then the term human rights has no meaning.

— Michelle Bachellete

September 27, 2010

Expensive maternity costs sending mothers to TBAs

Strength of a

Woman

By AJANGA KHAYESI

Anne Shitandi (left) a traditional birth attendant demonstrates how a fetal scope detects the baby in the womb. Poor handling of expectant mothers may result in complications.

— Picture: Ajanga Khayesi.

E

ssential hospital services by medical personnel, trained traditional birth attendants (TBAs) and herbalists’ have won the hearts of many expectant mothers depending on their accessibility in the prevailing community.

“Poverty forces families to seek for maternity services they can afford. This puts the lives of the unborn baby or the mother in danger,” says Mama Pauline Atieno.

Despite government efforts to eradicate TBAs, women in the villages and slum areas still seek their services.

Sabina Akinyi Okore, 55, is a traditional birth attendant at Bandani village in Kisumu. She started providing Nyamrerwa (midwifery services) at the age of 20 while living at Msambweni in Kwale District, Coast province.

“It is a trade I learnt from my mother who inherited the skill from her grandparents.” Okore has since worked in Mwanza in Tanzania and Nyalenda in Kisumu before settling at Bandani due to high demand for her services from the community. Many of her clients find hospital charges too costly.

Offering home and away services, Okore charges a fee of KSh1, 000 for delivering the first born baby and KSh800 for subsequent births.

Okore’s equipment includes hand gloves, cotton wool and a packet of

fresh milk. She also gives traditional herbs to expectant mothers.

She explains the impact of the traditional herbs given to her patients.

“The yadh mar rariu herb (drug for alleviating lower abdominal pain) widens the birth canal before delivery to allow the baby pass easily, chieth liech (derives from the elephant waste believes empower a pregnant woman) increases the mother’s strength during labour and seje ogugu (powdered foam mixed in hot water), is taken three times a day to stop excessive bleeding after delivery until bleeding stops.”

Okore keeps up weekly checks on enlisted patients while administering medicinal mixture of herbs and petroleum jelly for massaging the abdomen to adjust the baby’s position in the womb.

Training To curb maternal death in the lakeside city, the public health department at the Kisumu District Hospital rolled out a programme to train TBAs. Anne Shitandi was among the first beneficiaries of the programme.

Born in Mumias District, Shitandi moved to Nyalenda and was introduced to the trade by Filda Anyango, a traditional midwife.

Shitandi enrolled for the TBA public health training at Pandipieri Catholic church in Nyalenda. After

that, she enrolled for an 18-month training course at the Kisumu District Hospital nurse training centre where she advanced skills in mid-wife services, HIV/AIDS and identifying emergency cases among others.

Since the training shaped and opened windows of opportunities for her, Shitandi has assisted women from across Nyalenda to deliver safely.

Problem Shitandi has transformed her bedroom into a maternity ward admitting on an average four expectant mothers weekly. She charges each client KSh600 for delivery services.

“The most complicated conditions for an expectant mother include blood pressure, swollen legs and feet, and rupture,” explains Shitandi. She provides herbs that are used to reduce the risks for the mother and the unborn baby.

However, Shitandi cautions pregnant women against using traditional herbs after the first trimester “because they could harm the baby or block the birth canal.”

She says poor handling of mother during childbirth may result in complications like tampering with the reproductive organs or uncontrollable urine passage, death either for the mother, baby or both.

According to Shitandi, ‘previous

placenta’, a situation where the placenta comes out before the baby is born is common phenomena in Nyalenda particularly to mothers who do not attend antenatal clinics.

Kisumu East district community health worker, Ms Mary Omoka says the rate of maternal death has recently reduced following increased number of health workers in the area including those handling HIV/AIDS issues.

According to the Henry J. Kaiser Family Foundation, HIV transmission from mother to child is still high in Kenya. It is estimated that one in four babies born to HIV infected mothers are also infected.

hiv status According to the Kaiser report, women account for approximately twothirds of adults estimated to be living with HIV/AIDS in Kenya.

Often women do not disclose their status to their husbands for fear of being stigmatised, assaulted or thrown out of the home. It has even been reported that women fail to seek antenatal care from fear of their HIV status being disclosed during routine HIV testing.

Shitandi believes that HIV/AIDS may be a contributing factor to the health status of a pregnant mother and the baby but it is difficult to relate the death to HIV/AIDS “because HIV/AIDS itself does not kill but other related HIV causes may result the person into death.”

Strength of a

Woman

September 27, 2010

Circumstance and history has worked against women in producing the next generation. Grotesque double standards exist for women in developed countries yet they lack for developing countries. — Christiane Amanpour

15

Tragedy of hope gained amidst loss

By GODFREY MACHUKA

W

hen Benson Onchwati’s wife conceived and the scan showed that they were expecting twins, he had no reason to hesitate settling dowry payment since he had proven that his second attempt at marriage bore fruits.

With Onchwati’s first marriage they were unable to have children and parted ways even though he had paid dowry.

As he celebrated the fact that he was going to be father, fate had other plans. However, tragedy set in because immediately his wife gave birth, she died, leaving him the responsibility of caring for the twins alone.

“I was torn between joy and pain.

Joy that I had finally sired children and pain that their mother had no chance to live for us to bring them up together,” says Onchwati, wearing a distant look as he cuddles one of the twins, now six years old.

Apportioning blame Relatives tried to find an explanation to his wife’s death. Some tried to blame the first wife for the misfortune. They claimed she had bewitched the second wife in revenge to the man who had chased her away for failure to bear him children.

“My sisters, some of my aunties and a few villagers threatened to look for my first wife and lynch her as it happens to suspected witches,” explains Onchwati who hails from Nyamira District.

The first wife survived the wrath of his relatives when elders intervened and sought to understand the explanations given by medical doctors as to what had happened at the maternity ward.

“My sisters were with me when the doctors asked me to sign some documents to allow my wife undergo caesarean section, an operation that turned fatal as she lost a lot of blood after the successful delivery of the twins,” narrates Onchwati.

The elder’s action helped vindicate the first wife from the unfortunate death of the twins’ mother.

According to Onchwati, the task of bringing up the children on his own was the hardest he faced.

No baby sitters “I am the last born in my family so I had no experience of even baby sitting a child. This sudden responsibility was a tall order, made worse by the fact that the young ones were twins,” he explains.

Onchwati quit his job as a supermarket attendant in Kisii town

and relocated to his village in Magombo, Nyamira District to take care of his sons.

“Initially I had no one to help me look after the children because all my sisters are married and most of my relatives lived in urban centres. That left me with my aging and ailing mother to assist,” he explains.

“Household chores, shamba work and all the other duties that belonged to my wife strained me besides the bigger duty to look after the young ones.” He explains.

Equally, there was pressure from both family and friends that he should marry another wife to help him bring up the children, an idea he resisted for a while.

“It was just a month after my wife had passed away and I never believed another woman could bring up my children as their mother would have,” he says.

He braved the male chauvinism deep set in his community by washing and changing his sons’ nappies and hardly found time to meet with fellow men.

“I regret my rigidity to take the advice to look for a helper. For instance, whenever the babies cried I continued feeding them with milk thinking that they were hungry,” he reveals.

It later emerged that one of the sons, Eric, was sick and that Onchwati and his aging mother were late to seek medical attention and as a result he died. Eric died at five months and was diagnosed to have been suffering from pneumonia.

Losing a child “I blamed myself for his death.

Though I was naïve, I never sought medical attention, a thing so common when bringing up children,” regrets Onchwati.

It is during Eric’s burial that everybody who came to the funeral advised him to take another wife if he really wanted to see his other son grow up to adulthood.

“I was so afraid to lose Mike that I instantly agreed to marry again,” he says, cuddling the surviving twin.

“I now understand that a mother is a very important person in any child’s life and survival. Though I thought I will not

Benson Onchwati with his third wife Selina and son Mike outside their home in Nyamira District. The boy’s mother died immediately after he was born with a twin brother who also died after less than six months.

— Picture: Godfrey Machuka

require the services of another woman to help bring up my son, I was later forced by these hardships and married again,” he smiles looking at Selina, his third wife with whom he has a daughter.

Selina appears loving to little Mike who believes she is his mother.

Maternal deaths that occur during or shortly after pregnancy have had perennial residence in developing countries due to diverse reasons key among them being poor and insufficient health facilities, untrained or semi trained midwifes and retrogressive cultures where some people prefer to deliver children at home.

In Onchwati’s case, severe bleeding or haemorrhage was the cause of his wife’s death. Haemorrhage is the cause

“I now understand that a mother is a very important person in any child’s life and survival.”

— Benson Onchwati’

of about 25 percent of maternal deaths in the world.

A midwife at Thika District Hospital, Mr Richard Onchiri, attributes excessive bleeding to insufficient knowledge of the pregnancy’s development and inexperience of the person carrying out the delivery. “Most of these deaths are preventable if more care is taken on a particular delivery and efficient facilities are put in place to counter a probable fatal occurrence,” he explains.

However, he notes, some complicated incidents in which the mother of the newborn lacks sufficient blood clotting factor exposes the mother to excessive blood loss that often leads to death.

“Almost all rural public hospitals where child births are higher lack adequate facilities to counter such eventualities,” observes Onchiri. He adds: “Access to established facilities such as Nairobi Hospital becomes expensive for poor people therefore death becomes inevitable.”

Work with men so they can be part of the movement to save women from dying at childbirth.

16

September 27, 2010

— Ngozi Iweala

Strength of a

Woman

Gates takes the lead in jumpstarting funding for maternal health

By Rosemary Okello

L

eading by example is saying that often surpasses us all. But during the Women Deliver Conference in Washington in June, Bill and Melinda Gates Foundation took a lead in announcing support of new funding to address maternal, reproductive and new born health.

Making the announcement to great applause, Melinda Gates said the Foundation was giving $1.5 billion to the cause.

In a challenge to governments, multilateral organisations and private donors to commit at least $12 billion, Gates said the Foundation was taking the lead to jumpstart a global effort.

She urged world leaders in the developing and industrialised world to also do their part to prevent mothers and babies from dying.

“It is going to take government

efforts and investment to make it happen,” reiterated Gates.

“Every year, millions of new borns die within a matter of days or weeks, and hundreds of thousands of women die in childbirth,” Gates reminded the audience. She stressed: “The truth is we can prevent most of these deaths and at a stunningly low cost if we take action.”

Gates said she was inspired to take up the cause by the success in povertystricken countries like Malawi in Africa, where the government has trained 30,000 health workers who have been crucial to lowering child and maternal mortality.

“Sri Lanka, in South Asia, has instituted policy changes that cut maternal mortality dramatically,” she said.

Gate said the bulk of the $1.5 billion would go to programmes in India and

Ethiopia among several other countries where death rates among mothers and children remain stubbornly high.

The funds will be spent on training health workers, developing antibiotics for infections in newborns and treating post-partum haemorrhage in mothers.

She cited recent studies by the University of Washington’s Institute for Health Metrics and Evaluation and researchers in Australia that found the number of women dying from pregnancyrelated causes has dropped by more than 35 percent in the past 30 years — from more than 500,000 annually in 1980 to about 343,000 in 2008.

Additional information from the Wall Street Journal.

Melinda Gates gives a speech during the women deliver conference. The gates foundation has injected $1.5 billion to support maternal and reproductive health.

— Picture: courtesy Samhurd and women deliver.

Orphans still miss maternal love

By JANE KITHUMBA

E

sther Musyoka, 55, an aging granny and caregiver to Bahati Kathini, was left with the child after her mother died while giving birth.

“I did not know whether the child will grow up well and this is why I named her ‘Bahati’ which means luck.”

Bahati is now six years old and in standard one at Itivanzou Primary School. Her grandmother prepares her every morning and escorts her to school.

“She is very active and bright. I hope she will excel in her studies,” says an optimistic Musyoka.

School fees Bahati was born of a single parent but though the grandmother hopes that the girl would do well in her studies, she is at a loss wondering where she will get the money to finance her grandchild’s secondary and college education.

“I am too old and my days are numbered. I am worried because I do not have any son to take care of the education of this little girl,” she says.

When Bahati was a baby, one of Musyoka’s married daughters moved back home to help raise baby Bahati.

“After Bahati’s mother’s death, my daughter came with her children. We stayed with them as she helped me to look after the baby,” she explains.

However, her daughter had to eventually return to her marital home. Although Bahati was born at home, Musyoka’s

daughter took her the clinic for her immunizations.

Luckily, Musyoka has had no problem finding enough to feed her family. “I have my own farm that I plant beans, maize, sorghum and millet. Since my family is small, I am able to get enough food for my grandchild and I. Cultivating this farm at my age, is hard but my daughter organizers to have someone help cultivate the farm,” she says.

Bahati’s mother had goats, Musyoka would sell the livestock to cater for the baby’s expenses, buying things like glucose and milk. Bahati was a healthy baby. She says: “I thank God because Bahati would get minor illnesses just like any other baby, such as coughing and high temperature.”

This is confirmed by Bahati herself.

“I love my grandmother so much. She has been a good mother to me, loving and caring. I have not known any other mother in my life.”

She aspires to be a doctor when she grows up.

Unlike Bahati, Mary Maithya, 16, was left under the care of her father after her

mother died while giving birth to her.

Mary, the third born in her family, is now a Form Two student at Yumbe Secondary School.

“Parental love is very important, especially that of a mother although both parents are important,” says Mary.

She adds that although her father takes care of her and her siblings, she felt her life could have been better if her mother was alive to provide undivided love and care.

Mary is very active in her school work. She aspires to join the university in order to achieve her dream of becoming a doctor.

“I am very good in biology and chemistry and I know very well that I will pass my final examinations,” says Mary.

She adds that losing a mother is an unfortunate thing to happen to ones life. Mary stays with an aunt while their father works as a driver in Nakuru.

“Since I have never seen my mum neither have I breast-fed, l long for the company of a loving mum.”

Mary received maternal love from

“Since I have never seen my mum neither have I breast-fed, l long for the company of a loving mum.”

— Mary Maithya

her grandmother who raised her. Her father did not see the need to employ a helper to take care of the baby. He says: “My mother’s support was enough to care for my children when I was away.

And again, I have two sisters who are not yet married so with them all my children are well taken care of.”

Through his meagre earnings as a driver, he has been able to cater for his children, but his brother helps assists him pay fees.

Father’s love “Our dad loves us very much and he keeps encouraging us to strive to become dependable people in life. He plays the role of both father and mother; he always makes sure that there is enough food for all of us as well as providing for all our basic needs,” she reiterates.

However, he has faced challenges raising the children. “Every time I went home, my children kept on asking me about their mother. I used to tell them their mother is on a journey somewhere and one day she will come back,” he recalls.

Mary laments that there are many children who suffer because they have no mothers. She said through sharing of information with her peers in school she realised that most children whose mothers have died lack basic needs because their fathers cannot fill adequately the space of the departed mothers.

Strength of a

Woman

September 27, 2010

Together we can end fistula. We must strengthen maternal health systems, bring this to the attention of policy makers and communities and ensure that women living with fistula receive the care they need. —Thoraya Obaid

Report links TBAS to rise in obstetric fistula

17

By David Njagi

T

he dimly lit room is packed with household utensils suggesting this is the home to some ageing genius.

It does not take long before Emily Mteeshe, 60, proves that.

Reaching into a box safely tucked in one corner of the room, Mteeshe pulls out a pair of white gloves, wears them, before rhythmically falling into a crouch.

“I ask them whether they prefer giving birth while kneeling or lying on their back,” says the mother of one daughter who is a traditional birth attendant in the Kibera slum. “After the baby is born I wrap it in a warm blanket and place it on the bed as I wait for the mother to recover from the strain.”

Inherited skill This has been Mteeshe’s livelihood since she started practicing as a TBA in 1990. For KSh1500, she has brought joy to the hearts of many slum women who cannot afford hospital delivery through this skill that she inherited from her late mother.

“I started practicing during the year that Kenya’s Foreign Minister, Dr Robert Ouko was murdered,” recalls Mteeshe who is happy to have lived long enough to see the birth of her great grandchild.

She explains: “I have not had any formal training but the skills that my mother passed on have been very helpful.”

Mteeshe is one of the Traditional Birth Attendants (TBAs) in the country whom the 2008-2009 Kenya Demographic and Health Survey (KDHS) says assist in delivering 28 per cent of all births in Kenya.

According to the KDHS, Western and Eastern provinces account for the highest number of TBAs at 45 percent and 64 percent of deliveries respectively.

No training Like Mteeshe, however, most of the TBAs have not received formal training for the practice, making the process risky when the skills at hand fail.

For instance, delivery is carried out using crude tools such as razor blades, scissors and gloves which are not stored hygienically.

While most TBAs will not openly admit that their clients are sometimes vulnerable to complications, a report released in July links child delivery through TBAs to the rising cases of obstetric fistula and maternal deaths.

Released under the title I am Not Dead, But I Am Not Living, the Human Rights Watch report says lack of training and safe delivery tools could

Traditional birth attendants assist expectant mothers. Most TBAs will not openly admit that their clients are vulnerable to complications.

— pictures: gilbert ochieng and awc correspondent lead to complications affecting the mother or the child or both.

Unskilled TBAs “The reliance on TBAs over skilled attendants contributes to the occurrence of obstetric fistula and maternal deaths since they are not qualified to handle obstructed labour or other complications during delivery,” says the report.

According to the report, 14 of the women and girls researchers spoke to were kept in labour for more than one day by TBAs without being referred to a health facility developed fistula.

While in Kenya about 3,000 women and girls develop fistula every year, the report says those living with the condition but are not treated account for between 30,000 and 300,000 cases.

Reacting to findings of the report, Dr Amon Chirchir, a Reproductive

Health and Fistula expert confirmed that complications arising during child delivery can cause obstetric fistula.

“There is a high probability that deliveries that are not attended to by a qualified medical practitioner may cause a tear in the mother’s womb which often can develop into obstetric fistula,” explained Chirchir, who also practices at the Moi Teaching and Referral Hospital.

However, the concerns that the report are raising are not going unnoticed.

Grace Njinju, a community based health worker in Kibera slum is a volunteer who has been working with TBAs.

“The reliance on TBAs over skilled attendants contributes to the occurrence of obstetric fistula and maternal deaths since they are not qualified to handle obstructed labour or other complications during delivery.”

Her brief involves creating awareness with TBAs about the need to consult health experts on hygiene and skills that enrich their practice.

Obstetric fistula “The problem here is that even when we discourage these deliveries some mothers will secretly do it the traditional way,” says Njinju. She adds: “We know obstetric fistula is one of the complications that may arise but none will admit it.”

Next week Kenya will be expected to report progress on maternal health during the Millenium Development Goal (MDG) summit in New York.

While the government has indicated that it is committed to reducing maternal death and morbidity, health experts have raised concerns about the shoe string budget that has been allocated to maternal health.

18

Economic empowerment is essential to achieving MDGs. When women earn their income, they are more likely to spend money on food, water, medicine and other important family needs. — Ashley Judd

September 27, 2010

FGM hampers safe delivery

H

armful traditional practices such as Female Genital Mutilation (FGM) are being cited as part of the causes of maternal deaths due to complications experienced by women from communities practicing FGM during childbirth.

About 500,000 women worldwide who die during childbirth or due to complications after giving birth come from Sub-Saharan Africa.

Risks The World Health Organisation (WHO) defines FGM as a procedure involving partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural, religious or other nontherapeutical reasons.

According to the WHO, FGM is a common practice in the world with about 130 million women and girls estimated to have gone through the cut.

The practice according to WHO doubles the risk of a woman’s dying at childbirth and increases the risk of a child being born dead up to four times.

A study by the WHO Study Group on Female Genital Mutilation and Obstetrical Outcome conducted from 2001 to 2003, examined 28,393 pregnant women in obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan found out an association between the extensiveness of genital cutting and maternal and infant death rates during childbirth.

In the research it was established that obstruction can lead to prolonged labour which increases the risk of Caesarean Section, heavy bleeding, distress in the infant and stillbirth.

Women who have gone through FGM, are also more likely to undergo a surgical cut during delivery to prevent vaginal tears (episiotomy).

Outdated practice Adventist Development and Relief Agency (ADRA) Kenya, Western Kenya Anti-FGM Programme Officer, Mr Robert Onsando concurs that FGM continues to threaten women’s reproductive health but communities practicing it are adamant to abandon the outdated practice which has seen many women lose their lives or get disabled out of childbirth complications related to FGM. Despite being against the Ministry of Health Policy, Onsando laments the practice which is rampant in Kisii continues depriving young and unsuspecting girls of their reproductive health rights under the cover of retrogressive beliefs of reducing the girls’ risks of contracting HIV. “The issue of subjecting girls as young as five or six years to FGM, under the cover of reducing their sexual

Strength of a

Woman

By BEN OROKO

libido and risks of contracting HIV, is an outdated belief which continues exposing innocent young girls to irreversible maternal health related complications,” observes Onsando.

The medic observes that in Kisii about 79 percent of the girls are subjected to the cut with the local community members embracing the practice as part of the efforts to reduce the young girls sexual libido, which they link to promiscuity and risks of contracting HIV. Onsando expresses fear that girls from the Kisii community will continue suffering in silence from maternal complications related to FGM if the local community will not change their traditional beliefs and abandon the ageold retrogressive cultural practice.

Following fears of exposing the initiates to HIV risks through the traditional methods such as use of a single cutting device on multiple women.

Anti-fgm crusaders Onsando says it has forced perpetrators of the practice to seek services in private medical clinics, making the war against FGM in Kisii difficult. “Anti-FGM crusaders and advocates in Kisii are finding it difficult to replace the practice with alternative rites of passage since the proponents of the practice have changed tact to medicalisation where its proponents seek services of some unethical nurses to execute the cut in private clinics or in their homes,” reveals Onsando.

Ms Fridah Nyabate (not her real name), 32, a mother of two from Bomorasi Village, Nyang’iti location in Sameta District, is disappointed by FGM practice which she blames for her undergoing a Caesarean Section during the birth of her first and second born children.

For Nyabate, she has every reason to condemn FGM for exposing her to childbirth related complications, which she regrets have impacted negatively on her reproductive health status.

Caesarean section Despite attending her antenatal clinics in her first and second pregnancies, she was shocked to be recommended to undergo CS when she went to deliver both her first and second children following obstructed labour complications related to FGM. “Though I had successfully attended all my ante-natal care clinics as required, I was later recommended to undergo CS during the delivery of my first and second born daughters, following what the birth attendants described as obstructed labour complications related to FGM which I underwent when I was a young girl,” recounts

A woman with her baby in the kitchen garden in a rural Kisii home. Female Genital Mutilation is a cultural practice in Gusii and the women complain that it affects them negatively during child birth. — Picture: Ben Oroko Nyabate.

Following the painful experience she went through at the maternity ward during the delivery of her two daughters, Nyabate vows not to subject her daughters to FGM. Besides exposing women to irreversible maternal health complications during childbirth, fgm also deprives them of their reproductive health rights.

“As a mother and a victim of childbirth complications related to FGM, I feel affected when I hear someone talk of exposing young girls to FGM at this time when the world has changed tremendously,” says the mother of two.

Following the painful experience she went through at the maternity ward during the delivery of her two daughters, Nyabate vows not to subject her daughters to FGM.

Nyabate says what she went through has taught her a lesson that will remain permanently etched in her social, physical and psychological life.

Nyabate advises women from the Gusii community and those from other communities where FGM is practised to stand up against the outdated practice and assure young girls of their reproductive health rights.

Women and men from FGM practising communities should be educated on the dangers of the practice on the women’s reproductive health.

Ms Martha Moraa, 82, a resident of Nyambunwa village, Bassi Chache Location in Sameta District says FGM is a practice among the Gusii community with deep cultural attachments and it will not be easy for local conservative community members to abandon the practice.

“Unlike in the current situation where FGM has lost its meaning, in the past, during seclusion, the initiates were taught how to live harmoniously with the young, their age mates, members of the opposite sex or old people. They were also taught their history, traditions and beliefs.

Moraa advises the local communities to replace fgm with alternative rites of passage.

Strength of a

Woman

September 27, 2010

Investing in women is smart economics. As we improve and scale up we must put a lot of money in reproductive health, focusing on high fertility rates.

— Oby Ezekwesili

19

Myths hinder women from accessing attention on time

BY MICHAEL OONGO

W

hen Patricia Amojong, a mother of two children at Angurai in Teso District fell ill with a fever some weeks ago, her immediate reaction was to visit the local retail shop for pain tablets.

Two days later, the condition worsened and her husband, Mr Dennis Ekisa felt it would be better to buy a malaria drug at Chelele Muk market.

This he took back to his wife to swallow on the assumption that she was suffering from malaria.

Worsened state As her condition deteriorated two weeks later, her husband borrowed some money from a village mate to take her to Kocholia District Hospital about 20 kilometres from their home.

However, at the district hospital she was diagnosed with typhoid and admitted for further treatment. The husband on the other hand protested that he did not have money to pay for the inpatient fee. It took the intervention of the hospital staff for him to reluctantly agree to his wife’s admission.

In Nambale, Busia District, Ms Stella Nasirimbi, a mother of four children opted to go to a traditional birth attendant to assist in the delivery of her baby. But soon after delivery, she started bleeding profusely.

Her friends rushed her to the Busia District Hospital where she was wheeled into theatre for an emergency operation.

At the hospital, doctors worked frantically to save her life and after the operation, she was given blood transfusion to replenish what she had lost.

No awareness The above scenarios illustrate some of the factors contributing to maternal deaths in rural areas where awareness on health facilities is very low.

Lack of awareness and poverty has also forced some women to resort to self-medication through over-thecounter drugs even before getting illnesses diagnosed by a skilled medical professional.

A gynaecologist/obstetrician at the hospital, Dr Jane Rose Ambuchi says most women in rural areas usually seek medical attention when it is too late.

Most cases end up staying in hospital for an unnecessarily longer period compared to if they had sought medical attention in the early stages of their illness.

“We have cases where some female patients prefer to seek assistance from paramedical community based organisations that are not well versed to diagnose let alone treat them,” says Ambuchi. She reiterates: “Such women are only referred to better health facilities when their condition has deteriorated.”

Ambuchi says: “It is a pity that even some women with college education who should know better about their health usually do not take prompt measures to seek professional help on time.”

She continues: “Some communities still need to be educated to discard age old traditions which have become a major hindrance for rural women to access better health care.”

Behaviour change The doctor says that without behavioural change some women in rural areas will still suffer ill health despite the availability of health facilities in almost all corners of the country.

Ambuchi’s views are shared by the hospital’s medical superintendent, Dr Redemptor Atieno who says: “Belief in traditional healers and birth attendants is a big challenge in making available better health care services to women especially in some parts of Teso District where many people still believe in herbal medicine.”

Busia District Hospital’s Health Record and Information Officer, Mrs Jael Otieno says the men’s negative attitude towards maternal health has contributed significantly to the poor health status of most women in rural communities.

A traditional birth attendant in the rural area where many women due to myths and traditions prefer their services.

— Picture: Michael Oongo “These facilities are better equipped and can offer better medical services to the rural women only if they can be encouraged to visit them on regular basis,” says Otieno.

But some of the men interviewed disputed this claim maintaining that they were willing to provide for their wives’ health care. They said they are too poor to afford hospital charges and the cost of drugs which they claim were prohibitive.

James Otieno says: “It is true that we are the head of the family but the cost of medication at local hospitals is just beyond our means.”

He asks the Government to lower health services rates so that men can properly take care of their families.

Disclosure However, Pastor Charles Mdanga of Joint Outreach Christian Centre in Busia feels that although most men are willing to take care of their spouses’ health, the women are to blame for their poor health.

“Women are their own enemies because some of them are so secretive about their health that the husbands

Paternal support “Men are the heads of the family.

The family looks up to the man to provide money for medication but most of them do not seem to care about the family’s health,” she laments.

Some women also suffer silently in their homes when they fall ill because they fear reaching out to health facilities.

“Men should change this negative attitude and take up their responsibility of providing for their families in all aspects,” says Otieno. She adds that vigorous awareness creation targeting men especially on matters of maternal health should be conducted countrywide to sensitise them on the issue.

In Busia District there are enough government sponsored health centres and dispensaries that can adequately cater for the rural women but their husbands are not supportive enough to encourage them to attend them.

“If they realise you are poor, they will abuse you. If you are lucky to be attended to, they will prescribe drugs and ask you to go and buy them elsewhere.”

— Josephine Oyoo

only get to know about their sicknesses when it is too late,” says Mdanga.

He adds: “Most women in rural areas opt to seek family planning services without informing their husbands and their men only get to know of their sickness when their the pills bring complications.”

He poses: “How do you expect a man to be told to give money to treat family planning related ailment when he was not informed about it from the beginning?”

Mdanga argues that some women have the habit of feigning sickness whenever their husbands turn to them for conjugal rights, making the men not to take them seriously even if they genuinely fall ill.

Women interviewed, however, blamed their poor health on the high cost of medicine and huge bribes being demanded at government health facilities.

High cost Mrs Josephine Oyoo who hails from Nangina in Samia District laments that poor women are discouraged from seeking medication in such facilities because of the high cost of drugs. She also accused the health personnel of using abusive language.

“If they realise you are poor, they will abuse you. If you are lucky to be attended to, they will prescribe for drugs and ask you to go and buy them elsewhere,” she says.

However, a resident of Busia town, Mrs Joyce Anyango, claims that despite the belief that better services could be received from government run institutions, it was far from the truth.

“The facilities are inadequate and those which are available are in a sorry state thus contributing to an unconducive health environment,” she argues.

Records available at the Busia District Hospital indicate that malaria and haemorrhage were the biggest threat to expectant mothers. Doctors say the two ailments were common among women who sought medical attention when it is too late.

Maternal care is not the only health service that women need.

There is also family planning where they get to choose when to get pregnant and the number of children to have. — Prof Gamal Serour

20

September 27, 2010

Strength of a

Woman

Smart card introduced to ease maternity services

By DOSELINE KIGURU

A

s a result of pregnancy related complications, a total of 21 women in Kenya die every day. These figures translate to about 7,000 women annually.

The reason why many women die from child birth and pregnancy related complications is because many of them prefer giving birth at home under the care of unskilled birth attendants. This has been attributed to the high cost of maternity care in health centres.

But soon these figures may go down if a new initiative by Pumwani Maternity Hospital holds ground. With the introduction of the Changamka Pumwani Maternity Smart Card, mothers will have every reason to visit the facility during pregnancy and at child birth.

Insurance The Smart Card is a personal health insurance cover for expectant mothers that allows them to start saving for their delivery fees early in the pregnancy.

The prepaid card enables the mothers to save and get ready to pay all their maternity bills when the time for delivery comes, thereby, reducing cases of maternal deaths in the hands of unskilled birth attendants.

Women at an ante-natal clinic at the Pumwani Maternity Hospital. The smart card that is going to make it easy for women to save for maternity services. — Picture: Doseline Kiguru The move is in line with the UN Millennium Development Goal number five whose target is reducing maternal deaths by three-quarters and achieve universal access to reproductive health by 2015.

The usual charges for delivery at the Pumwani Maternity Hospital range from KSh3,400 to KSh5,000 for normal delivery and KSh8,000 to KSh10,000 for the Caesarean Section delivery.

The Changamka Pumwani Maternity Card, therefore, enables poor women

have a reliable saving system to ensure they are fully prepared after the nine months.

“Usually, many of the poor mothers wait until the ninth month to start looking for money. This forces us to retain the women here in the hospital because they are unable to meet maternity costs. This is what we want to reduce,” says Dr Fridah Govedi, chief executive officer at the Pumwani Maternity Hospital.

The card which goes for KSh500

can be used to pay for all services at the Pumwani Maternity Hospital including pre-natal and ante-natal care, normal and caesarean section delivery as well as any other pregnancy related conditions. After the purchase of the card, it comes loaded with KSh300 and the cardholder can then start to save.

The card can be topped up through Safaricom’s M-Pesa service or in the designated stations in various hospitals and health centres. There is no limit CONTINUED ON PAGE 22

Technique encourages women to seek skilled care

A

new initiative, the Outpatient Based Approach (OBA), has been introduced to help women heavy with child get low cost maternal and antenatal care.

The reasoning behind the launch of the card is that it will encourage women to seek skilled birth attendants and in the long run reduce the rate of maternal mortality.

The pilot programme is being implemented in Kitui, Nairobi, Kiambu and Kisumu. It entails pregnant mothers buying a card at KSh200 which enables them to get maternal and antenatal services during pregnancy and six weeks after delivery.

“In 15 percent of pregnant mothers, serious obstetric complications that usually cannot be predicted or prevented in advance can occur,” says Kinako Musembi, proprietor of Kitui Neema Nursing Home which is implementing the project in the area.

Musembi whose health facility specialises in reproductive health says only 20 percent of pregnant women in the country deliver under the care of skilled health professionals while 80

By MUASYA CHARLES

Kinako Musembi proprietor of Kitui Neema Nursing Home where a card is used for maternity services. Only 20 percent of Kenyan expectant mothers deliver under care of skilled health care providers. — Picture: Muasya Charles percent deliver at home under care of traditional birth attendants.

Before the OBA service was introduced in 2006, the hospital only recorded three delivery cases a month unlike now when about 150 cases are recorded.

“Most of the complicated cases needing operation have been handled by the TBAs,” observes Musembi. He adds: “Most expectant mothers even those without jobs are seeking services at

private hospitals because they only require the KSh200 card.”

He explains that a newborn is delicate to handle as it is prone to infections especially sepsis, a common disease in children up to six weeks.

“A new born child should be wrapped immediately in warm clothing to restore warmth. Washing the infant in cold water exposes the child to cold, fever and respiratory complications,” he explains.

Proper services

Musembi attributes the high number of women giving birth at home to high charges in government hospitals. However, through the OBA even poor rural women can get proper services at private institutions.

“Outpatient Based Approach is funded with support from the German Government through the Kenya Government and for the four years it has been tried in the project sites, it has improved maternal and ante-natal

services,” explains Musembi.

He reiterates that maternal and pre-natal deaths occur mostly when pregnant women fail to get access to skilled maternal care throughout pregnancy, delivery, postpartum and postnatal periods.

Musembi asserts that maternal death results from direct obstetric complications of postpartum haemorrhage, obstructed labour, eclampsia, puerperal sepsis and unsafe abortion.

A nurse at Kitui General Hospital, Mr Michael Mulinge says poor access to skilled reproductive healthcare by women in the rural areas and urban poor impede safe motherhood, maternal and neonatal health.

Other challenges include inadequate access to improved care of the newborn including facilities for resuscitation, thermal regulation, infection prevention and promotion of early and exclusive breastfeeding.

There is need to remove barriers that impede access to skilled care for the poor and ‘hard-to-reach’ women including promotion of community midwifery services.

Strength of a

Woman

September 27, 2010

Battle for women’s health is a struggle and the enemy is political indifference.

— Michelle Bachelette

21

Only a partnership can stop the deaths

By Jane Godia

A

t the heads of State and governments meeting in New York to review the Millennium Development Goals (MDGs), focus was on Goal Five that seeks to reduce maternal mortality and improve maternal health.

Statistics from Kenya, among other developing countries are giving an indication that this target is far from being met. Goal Five has made the least progress among all the others and remains the most underfunded of all MDGs. It is because of the lack of tangible results that the United Nations Secretary General has called for a Joint Action Plan with member states and other development partners to look into maternal health through a partnership lens.

Collaboration Mr Ban Ki Moon, who has called for collaboration among governments, development partners, non-government organisations and the UN itself to put in more efforts to end the sad story of mothers dying when giving life.

On June 11, Moon launched the Joint Action Plan to help improve maternal health. The Joint Action Plan calls for urgent and strategic efforts as well as urges all stakeholders, developed and developing countries, civil society actors, private businesses, philanthropic institutions and the multilateral system to each offer new initiatives. It calls on them to adopt an accountability framework that will keep maternal and child health high on national and international development agenda.

Speaking at the Women’s Deliver Conference in Washington, the Secretary General reiterated that “investing in women’s health must be at the centre of achieving the MDGs”.

In launching the partnership he said: “Only a global partnership can stop the death. There must be a renewal of commitment for governments to deliver for women and children.”

Action He added: “This is a call to action for governments and all health infrastructures to work together in collaboration with non-government organisations, community based organisations, civil society organisations and international organisations.”

Moon said: “The piece meal approach has been tried but it has not worked. We must fight for women’s health in a joint action.” He explained: “This has worked for HIV/Aids and malaria since it has a framework to track progress and accountability.”

Accountability is important to ensure that the collective approach to improving women’s health can be

A group of mothers from the Nyalenda slum in Kisumu with their children who were delivered with the help of traditional birth attendant. Lack of political will has hindered progress in meeting maternal health targets in MDG Five. — Picture: Ajanga Khayesi. realised. The accountability framework in the Joint Action Plan will track policy, programme and financial commitment of all stakeholders involved. It will also show how commitment contributes to improvement of women’s health at local, national and global levels.

He called on the G8, G20 and African Union to make maternal health a priority reiterating that in working together, the UN aims to make 2010 a turning point for women’s health.

Sadly, thousands of maternal deaths in Kenya rarely get a mention. The fact that 8,000 women die from preventable pregnancy complications has attracted little attention. The deaths neither get space in the media, nor does the government order that flags fly at halfmast. There are no 21-gun salutes or a requiem mass for the dead women’s souls so that may rest in eternal peace.

The numbers Yet, the statistics are astounding. To drive the point home, Dr Nancy Kidula of the World Health Organisation uses a matatu allegory.

“Take the case of an accident involving 16-seater matatus (public service vehicle) with a passenger capacity of 500 or 80-seater matatus with a 100 passenger capacity and all people on board perish,” she says.

These numbers translate to 8,000, which is the annual maternal deaths in Kenya every year. In other words, every hour a woman dies from pregnancy related causes. This makes it about 21 women, on average, dying every day from pregnancy related consequences.

The lifetime risk of death from pregnancy in Kenya is one to 39 as compared to one in 17,400 in Sweden.

There are also major regional disparities. In Nairobi, between eight and nine out of 10 babies are delivered in health facilities while in North Eastern Province up to between eight and 10 babies are born at home without the help of skilled medical personnel.

Kidula says: “Women in Kenya are dying because of pregnancies and other related causes. When women die from pregnancies and related causes or get disabilities because of pregnancy it is considered normal. Safe motherhood is a right and no one should die or suffer disability from it.”

Like many African countries, Kenya has not invested enough in health. The country’s health budget remains low and is only about six percent of the total national budget.

Snow bow effect When a mother dies, there is a snowballing effect and many matters come to play. For one Kidula says, the baby will most probably die with the mother or soon after. The family will be destroyed in the absence of the mother as it will not be able to hold together. Children will also drop out of school as there will be nobody to guide them and the whole family set up will disintegrate.

Kidula stresses: “Women are the

cornerstone of economic development and when they die a nation cannot develop.”

According to Mrs Linah Jebii Kilimo, MP and Assistant Minister, the statistics will continue being worse as long as men remain the gatekeepers and decision makers. “Men have put in place rigid rules when it’s not about men,” she says. “Leaders must understand that the foundation of the nation is the women and we must keep them alive.”

Kilimo who is the chairperson of the Kenya Women Parliamentary Association (KEWOPA) says other than patriarchy being a stumbling block to improving women’s health, culture and myths are to blame for the large number of women dying from pregnancy related consequences.

“There is need to create awareness among women on the need to attend clinic during pregnancy,” Kilimo says.

She challenges leaders, and specifically politicians to stop maternal deaths by influencing a culture that stops women from using health facilities when pregnant.

Even as she appeals to development partners to help, Kilimo says: “We need to act now, today and not tomorrow.

We have to look inside before we look outside with what we have in our hands.”

Supportive legislature

“The piece meal approach has been tried but it has not worked. We must fight for women’s health in a joint action.”

— Ban Ki Moon

Law makers need to play a vital role in making maternal survival a national priority and supporting enactment of supportive legislation that addresses root causes of maternal death and disability from pregnancy.

MDG Five can be achieved but only if there is political will and financial investment. The government should increase financial allocations for maternal health programmes to ensure all women in Kenya, regardless of their social status, have access to the quality maternal health services.

22

If nature had arranged that husbands and wives should have children alternatively, there would never be more than three in a family.

— Lawrence Housman

September 27, 2010

Strength of a

Woman

Why ante-natal care remains a necessity

By Mary Amuyunzu

W

omen who have had many children are less likely than women with fewer children to seek ante-natal care.

According to the Kenya Demographic and Health Survey (KDHS) 2008-2009 rural women are less likely than their urban counterparts to get ante-natal care from a doctor.

But is ante-natal care important for a pregnant woman?

Vallerie Monari, who is in her last trimester, speaks of her experiences in seeking ante-natal care and what it means to her. This is Monari’s second pregnancy for which she began antenatal care at nine weeks.

She says: “I took a pregnancy test and immediately began ante-natal care.

When the doctor informed me that I was expecting twins, I was overwhelmed. I did not know whether to laugh or cry, it was just too much for me.”

Monari started ante-natal care early because she understands its importance in monitoring the health of the mother and the unborn child.

She says: “At this stage there are vital tests done to ensure that all is well with the pregnancy.” She adds: “I wanted to be sure that the twins were safe. I also wanted to know how to take care of myself and to stay healthy for the sake of the twins.”

Education The KDHS results show that women’s level of education determines how they view ante-natal care. Women with higher education are more likely to receive ante-natal care from a medical doctor than those with no education.

This can be looked at the ratio of 36 percent compared to 21 percent.

The proportion of women who do not get ante-natal care declines steadily as the level of education increases. A sad fact is that one in every four women CONTINUED from PAGE 20

on top-ups. The amount required for any health care that the card holder seeks is deducted directly from the card. However, the minimum operating balance for any service at the maternity hospital is KSh450.

The card which was developed after an agreement between Changamka Microhealth Limited and the Pumwani Maternity Hospital also covers outpatient services. It covers consultations, laboratory tests, prescribed drugs and dressing.

“The card entitles the holder to primary health care at designated clinics and one treatment shall mean consultation, one test and drugs for one diagnosed ailment,” says Mr Cliff Radido of Changamka Microhealth Limited.

The card, however, is not limited to

with no education does not get any antenatal care at all.

Although all pregnant women are required to seek ante-natal services not all of them do it. The reason why a lot of stress is put on ante-natal is because it enables doctors and other health care personnel follow up on the help the woman will need. Ante-natal care is important for when there is a history of pregnancy complications. It is also necessary when a woman is expecting multiple births or when she has a medical condition that is likely to complicate the pregnancy such as high blood pressure.

The World Health Organization (WHO) recommends that women without complications should have at least four ante-natal care visits, the first of which should take place in the first trimester.

Ante-natal visits

it is good to get ante-natal care so that the mother is up to date with the progress of the babies and is advised accordingly of any eventualities.”

She acknowledges that some of the services, especially the scans are costly, therefore not many would-be mothers can afford them. This could partly explain why some women fail to seek care during pregnancy.

Public health facilities do not charge for ante-natal care and the medications they provide are affordable and necessary.

There are marked regional variations in ante-natal care coverage with over one-quarter of women in North Eastern Province not getting any attention at all. Women in Western and Nyanza provinces have low reliance on doctors for antenatal care compared to their use of nurses, while for Coast and Central provinces the reverse is true.

Valerie Monari in her last trimester. She encourages all mothers heavy with child to go for ante-natal care.

The KDHS results show that only about 15 percent of women seek care in the first four months with most initiating ante-natal visits within four to seven months.

Monari says of her ante-natal visits: “I have had three obstetric ultra sounds done to check the position of the babies, heartbeats, cardiac activity, any abnormalities and to reconfirm age of my pregnancy.” She adds: “I have also been given medication to help control nausea and supplements called “momto-be” which contain vitamins and folic acid among other minerals.

Monari says: “In addition, I have benefited from health talks given to mothers during clinic visits.”

A health care professional is assigned during clinic visits to give talks to the expectant mothers as they wait to see the doctor. These talks are good especially for first time mothers, although refreshing the knowledge of second time mothers is also important.

Monari says: “With a twin pregnancy

It is anticipated that with the new Constitution, under the Bill of Rights, more women will access quality antenatal care and other health services. The decentralisation of health services to the county level presents an opportunity for increased access for women who have traditionally been forced to travel long distances in search for services.

However, it is notable that although about 92 percent of pregnant women visit an ante-natal clinic at least once, only 43 percent deliver in health facilities. This is mainly due to cost, cultural and other logistical issues that make it difficult for poor women to access delivery care. Monari plans to deliver at the largest referral hospital in east and Central Africa, the Kenyatta National Hospital.

She says: “It has some of the best and up-to-date facilities. It has a

neonatal intensive care unit and nursery for babies.” She adds; “It is also well equipped for emergencies especially for multiple pregnancies. I need a facility where I can feel safe without worrying about exorbitant costs.”

Her wish is to get good care and have a safe delivery. She also wants her husband to be by her side during the process. She considers this important because of the twin pregnancy poses a higher risk of complications more so if the babies come earlier than expected.

Monari urges that all women should access ante-natal care early enough so that they know the status of their pregnancies.

It is lack of awareness on the importance of ante-natal care that makes many women treat it trivially and hence the high maternal mortality rates.

the buyer and can be used by anyone bearing it.

Speaking at the Pumwani Maternity Hospital during the launch of the card, several expectant mothers expressed their interest in the card saying it would go a long way in preventing maternal deaths and quality of life for both mothers and children after delivery.

For 23-year-old Hellen Nyambura, the introduction of the card was a welcome relief. She is six months pregnant with her third child.

Nyambura who lives in Huruma Estate in Nairobi learnt about the card from a friend and headed to the maternity hospital to get more details. She was five months pregnant when she started saving.

“Many people find it odd that when the time comes to deliver, a woman has

saved no money. They do not realise that it is not easy to save in cash when you have other children to take care of because needs keep arising every day and you find yourself taking out all the cash you have saved,” says Nyambura.

She adds: “But this form of saving will ensure that I use the money for the intended purpose.”

The card was also a relief to many other women who are either unemployed or are in the informal sector with no health insurance cover.

One such mother-to-be is Mama Amina Ramadhan who learnt about the card when she went for the pre-natal clinic.

“I am happy that I can be able to use the card even after I deliver and that other members of my family can also benefit from it,” says Ramadhan. She adds: “The card offers an easy and safe

way to save money for health care.”

Ramadhan who was accompanied to the clinic by her mother-in-law, Aisha Njoki Ramadhan, who was elated to learn that the whole family could benefit from the card.

Ramadhan who lives with her mother-in-law in the Majengo area near the maternity hospital noted that many of the women in her neighbourhood had opted, for many years, to deliver babies at home despite the fact that the maternity hospital was so near.

“My mother-in-law delivered all her children at home but some of them did not survive. But I am happy that many women will now be able to afford the maternity fees charged and will have better and safer deliveries not only for the babies but for the mothers as well,” she explains.

Bill of rights

— Picture: Mary Amuyunzu

Strength of a

Woman

Somewhere on this globe, every ten seconds, there is a woman giving birth to a child. She must be found and stopped.

September 27, 2010

— Sam Levenson

36 years old with 23 children

I

t is said in the Bible that God told the people: ‘Go ye and multiply’. One man in Moyale is literally carrying this order to the letter. At 43 and his wife at 36 they already have children that would make up two classrooms in some of the prestigious schools. In the public schools the children would make up half the number in a class. By all indications there are no signs that they are going to stop soon. Perhaps they will stop only if the woman dies on the mat that forms her delivery bed.

Amina Mohammed once dreamt of being a doctor. She was born in a large family of 12 children but she always harboured big dreams. Unfortunately her parents did not have a stable source of income. They had to think of ways through which they could increase the family’s wealth. What was the best option? To marry off Amina so her bride price could help uplift the family status.

This meant that she would have to drop out of school, her dreams shattered.

“I managed to go up to Standard Five. Being the first born, my father told me that I had to leave school and be married off to bring wealth to the family as culture demanded of girls.”

Early marriage Amina who comes from a community in Moyale, North Eastern Province of Kenya had no alternative but to bow to her father’s demands. “It all started one bright July morning in 1989 when my father came with a man who was seven years my senior. He introduced himself as Faisal Mohammed and he was to be my husband.

“The man had accompanied my father that morning to inform me that by evening, I was supposed to be in his house since he had paid the entire bride price that my dad had asked for.

“I was disillusioned. The information was too much for me to digest. It was demeaning and astonishing. Our cultural norms do not allow women or even girls to question anything their parents say, especially fathers. I could not ask what would happen to my education!

“My father and the man hurriedly left since they had conveyed the intended message. I wept like one on a death sentence.

Education curtailed “This is not what I expected from my father. I was only 15 years! I pleaded with my mother who was equally out of the picture to at least convince my dad to defer the marriage plans until later but it was all in vain.

“By sunset, group of middle aged women, girls and young men from my husband’s family came to get me out of my parents’ home.

“That was a bad day for me. I had not eaten, packed my bag or even

23

By Venter Mwongera

bathed after learning of the unexpected marriage plans. They met me in a haggard condition and they did not care much about my physical appearance or even feelings.

“They entered the hut where I was, grabbed all my belongings and dragged me out of the compound to the man’s home. By 8.00 pm, I was already in his house and expected to be the dutiful wife!

“I wept the whole night since my pleas fell on deaf ears. In the morning of the following day, my husband was bragging to his brothers how lucky he was to have spent a night with his wife.

Deliveries “Nine months later, I gave birth to a set of twins, girls. My husband was not amused since he expected to get a son for a first born. According to him, I had not given him a child despite the fact that I had given birth to twins.

“A year later, I gave birth to fraternal twins. I was relieved. To date I have eight sets of twin births and seven single births. In total I have 23 children at only 36 years.

“It has not been easy because I have delivered all these children at home with the aid of a traditional birth attendant.

“When I conceive, give birth and come out alive, I thank Allah since all my deliveries have not been easy particularly having twins.

“Bringing up the children has not been easy. By the time we had six children, I mentioned to my husband about family planning. He was very angry and threatened to kill me if I used any birth control method since he believes in giving birth to many children and filling the earth.

“The nearest hospital that one can deliver in is more than 100 kilometres away and there is no means of transport apart from camel drawn carts or riding on the back of a camel. The roads are pathetic hence it is double tragedy to a woman who is pregnant.”

Amina’s husband, Mohammed believes only in the TBAs and the report his sisters give after she has delivered delivery.

“So, whether the hospital is near or far is not a factor. I have to follow my husband’s orders to deliver at home just as his mother and sisters did.

“My husband has even isolated me from friends who advise me to use any family planning method terming them

At 36 Amina (not in picture) is a mother of 23 children. She does not have the power to use a suitable family planning method.

— Picture: awc correspondent as killers and non-believers. I once told him that I will start taking pills that my friends told me are effective but he almost killed me.

“Every time he comes in the evening he searches the entire house including my bags and body just to make sure that I have not started using any contraceptives.

“Since the hospital is too far, I have never received any immunisation that I hear pregnant women get. Instead, there are concoctions that my motherin-law gives me to drink. Even my children have never been taken to any hospital for immunisations. Their father prepares some herbs from certain trees which we give them and they hardly fall sick.

Immunisation “Although on occasions when the Government does door to door immunizations for children, I allow them to get immunised against my husband’s will especially when he is not at home.

“My last birth almost cost me my life. I delivered two babies at an interval of two hours. The delivery was extremely painful and the TBA had given up on me. I had serious haemorrhage. She worked hard to save the lives of the children but by God’s grace, I survived to tell the story.”

Amina says having a large family has never been an easy. All the children need her attention in the view of the

“By the time we had six children, I mentioned to my husband about family planning. He was very angry and threatened to kill me if I used any birth control method.”

— Amina Mohammed, mother of 23

fact that the 23 children are aged between 21 and 2 years.

Since she got married, Amina has never had time for herself or even to think about her own life. “During the day, I am a mother and at night I am a wife,” she says.

My husband owns two camels that he uses to put food on the table.

Other times, my brother-in-law, Ahmed Jamal, who is the most educated in the family chips in. The furthest that all our children have gone in education is Standard Eight.

Contraception “Two months ago, Jamal told me to think about a long term method of family planning that I would want to use. He wanted to pay for me to do it without my husband’s knowledge.

“Initially Jamal talked to him about the burden of rearing a large family and the effect it could have on my body as a result of carrying too many pregnancies.

Instead of answering, my husband slapped him and spat on his face.

“I am contemplating on taking up Jamal’s offer because these pregnancies are having a negative effect on my on my body. I am becoming weaker and weaker everyday.

“I thank Kenyan citizens for voting in the new constitution that is in favour of women. I am optimistic that with creation of counties and equal distribution of resources more hospitals, clinics and dispensaries will be available to all people especially to women.

“I long for a day when culture and religion will not be used as a form of torturing women, a day when a woman’s voice will be heard, a day when women will not be treated as slaves and a day when women will be treated like human beings. That will be a new dawn for me. * Names have been changed to protect the identity of the people in the story

The importance of policies is that they make life better for women.

A woman’s access to services determines the choices she makes.

24

— Oby Ezekwesili

September 27, 2010

Strength of a

Woman

Gap in maternal health remains conspicuous

By DUNCAN MBOYAH

I

t is 10 years since the Millennium Development Goals (MDGs) were set. As world leaders review the progress made so far, they need to re-examine policies and commitment, assess obstacles and gaps as well as agree on concrete strategies and actions to meet the goals by 2015.

The Millennium Declaration in 2000 was a milestone in international cooperation, inspiring development efforts that have improved the lives of hundreds of millions of people around the world.

But unmet commitments, inadequate resources, lack of focus and accountability as well as insufficient dedication to sustainable development have created shortfalls in many areas.

Disparity Maternal health is one of the areas in which the gap between rich and poor is most conspicuous. While almost all births are attended to by skilled health personnel in the developed countries, less than half of women receive such care in the Third World.

Disparities in access to care during pregnancy are also striking, with women in the richest households 1.7 times more likely to visit a skilled health worker at least once before birth than the poorest women.

In the Kenya Demographic and Health Survey (KDHS) 2008–2009, 92 percent of Kenyan women received some antenatal care from a skilled provider. Just about 63 percent have received care from a nurse or midwife. However, only 15 percent of women had an antenatal care visit by their fourth month of pregnancy as is recommended. And just about 47 percent received the recommended four or more visits.

However, less than half of pregnant women in developing regions and only a third of rural women receive the recommended four visits.

The KDHS 2008–2009 shows a rise since 2003 in medical ante-natal care.

Trends in use of ante-natal care show that the proportion of women who had antenatal care rose from 88 percent in 2003 to 92 percent in the 2008–2009 survey.

Less than half of pregnant women in Kenya make four or more antenatal visits to hospitals. Comparing trends since the 2003 KDHS, it shows a continued decline in the proportion of women who make four or more visits from 52 percent in 2003 to 47 percent in 2008–2009.

Two-thirds of women took iron supplements during pregnancy.

However only 17 percent took intestinal parasite drugs. Of the women who attended ante-natal care, about 43 percent of women were informed of signs of pregnancy complications. It also indicates that about 73 percent of women were protected against neonatal tetanus.

Hospital birth In Kenya only about 43 percent of births occur in health facilities, 32 percent in the public sector and 10 percent in private sector facilities. Fiftysix percent of births occur at home.

Home births are more common in rural areas 63 percent than urban areas 25 percent. The most common reasons given by women who did not deliver in a health facility were that they were located too far or they had no transport.

About 21 percent did not think it was necessary to deliver in a health care facility.

Most women interviewed during the KDHS survey said they did not deliver in public health facilities as they did not have means of transport. They also said they could not meet the cost of delivering at the facility. Lack of female providers in the facilities was also cited in many communities, tradition does not allow women to be delivered by men.

Only 44 percent of births are assisted by a skilled provider — doctor, nurse or midwife. Another 28 percent are assisted by traditional birth attendants and 21 percent by untrained relatives

A mother with her child at the Coast General Hospital.

Unmet commitments, inadequate resources, lack of focus and accountability have posed challenges towards meeting of MDGs. — Picture: Correspondent or friends. Seven percent of the women did not receive any assistance.

Preventing complications Post-natal care helps prevent complications after childbirth. Forty-two percent of women received post-natal check up within two days of delivery.

However, more than half of women did not get post-natal care.

According to the KDHS 2008-2009, maternal mortality ratio for Kenya is 488 per 100,000 livelihoods.

But the UN MDG 2010 report indicates that in sub-Saharan Africa, the proportion of urban women who received antenatal care increased from 84 per cent in 1990 to 89 per cent in 2008.

The corresponding proportions for rural women are 55 to 66 per cent, indicating that coverage has improved at a faster pace among rural women.

Preliminary data show signs of progress, with some countries achieving significant declines in maternal mortality ratios.

In all regions, the adolescent birth rate (the number of births per 1,000 women aged 15 to 19) decreased between 1990 and 2000. Since that time, progress has slowed and, in some regions, increases have even been recorded. The highest birth rate among adolescents is found in sub-Saharan Africa, which has seen little progress since 1990.

Inequities in access to antenatal and postnatal care as well as medically assisted deliveries contribute to the high maternal mortality rates. Mothers in urban areas (94 percent) and mothers with some secondary level of education (93 percent) are more likely

to report receiving antenatal and postnatal care than rural (72 percent) and uneducated mothers (74 percent).

Others are aversion to caesarean section and unaffordable costs of antenatal care, delivery care and postnatal care. Basic essential obstetrics care is also not available in most facilities and many doctors and health workers are reluctant to serve in rural areas.

The situation has been compounded by the prevalence of HIV and Aids which compromises women’s immunity during and after pregnancy. Due to economic hardships, households continue to experience serious financial constraints in attending to their health needs.

Family planning Ensuring that family planning services reach poor women and those with little education remains particularly challenging.

In these countries, contraceptive use is four times higher among women with a secondary education than among those with no education, and is almost four times higher among women in the richest households than those in the poorest households. Almost no improvement has been made over time in increasing contraceptive prevalence among women in the poorest households and among those with no education.

Surveys conducted in 22 countries in sub-Saharan Africa show that contraceptive use to avoid or delay pregnancy is lowest among rural women, among women with no schooling and among those living in the poorest households.

Produced by: African Woman and Child Feature Service P.O. Box 48197 - 00100, Nairobi Tel: 254-20-2724756, 2720554, Fax: 254-20-2718469 E-mail: info@awcfs.org

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