Written by David Indeje
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Expectant mothers still die from four major causes: severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortion.
Early November 2010, a student of Moi Girls Kamusinga , Bungoma County died after abortion attempt. The principal of the school Mrs. Josephine Wanyama said that the student was in class when she screamed due to excruciating labour pains but later died when she was being rushed to hospital for medical attention.
The doctor’s report confirmed that the student, who had been under his grandma's care, had attempted to flush out the 5 month foetus after the doctors found its remnants after operating on the student.
This is one case of the number of teenagers who are dying in an attempt to procure an abortion.
However, how many girls do we have that are lured into this trend of purchasing a Sh400 ‘Postinor-2 tablets’ dose commonly referred to as P2 (An oral emergency contraceptive which can help prevent pregnancy if taken within 72 hours of unprotected sex) easily accessed in pharmacy?
Another sad story by Kwamboka Oyaro, began as:
"The foetus is not growing. We need to clean you up," the doctor at a private clinic in Kisii County told the desperate woman who was looking forward to the birth of her baby, after years of trying to conceive. The words were cold, even numbing.
"Why isn’t my baby growing?" she frantically sought an explanation. "Nobody knows why that happens but you need to be cleaned immediately," the doctor said with finality and turned to answer a call on his mobile phone. The woman looked at him in horror as he joked and laughed with the caller.
Yet, at private hospital in the same county, money changed hands as a woman was in labour. Her husband did not want another child and instructed the health workers to tie her fallopian tubes (tubal ligation, a permanent family planning method) as she underwent a C-section. She was never given a chance to discuss this issue and decide for herself that she wanted her reproductive chapter closed.
What about, 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 scenarios are common when it comes to reproductive and maternal health, scenarios of failed policies and of ignorance, of lack of political commitment, inefficiency and unprofessionalism; Stories that simply reveal the conspiracy to deprive women of access to maternal health care and facilities. It is just a conspiracy of death.
Ten years ago, the Government committed itself to ensure that Millennium Development Goal number five was realised by 2015. The goal states: Achieving good maternal health requires quality reproductive health services and well-timed interventions to ensure a woman’s safe passage to motherhood.
“Unsafe abortion is one of the continent’s biggest threats to women’s health. While abortion is safe in countries where it is legal and provided by trained medical professionals, clandestine abortion in most of Africa leads to death and serious injury,” says President of Guttmacher Institute, Sharon Camp.
Camp notes that, more than 26,000 African women die as a result of unsafe abortion annually as another 1.7 million are hospitalised, and many others suffer serious health complications, but do not seek treatment.
According to a report released last September, trends in maternal mortality by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA) and the World Bank showed that the number of women dying due to complications during pregnancy and childbirth has decreased by 34 per cent from an estimated 546,000 in 1990 to 358,000 in 2008.
However the report states that, progress is notable, but the annual rate of decline is less than half of what is needed to achieve the Millennium Development Goal (MDG) target of reducing the maternal mortality ratio by 75pc between 1990 and 2015.
One reason is that as a result of improved diet and better standards of living, girls now get their first menstruation quite early. Today, girls aged between nine and 13 are becoming pregnant.
Every day, about 1,000 women died due to these complications in 2008. Out of the 1,000, 570 lived in sub-Saharan Africa, 300 in South Asia and five in high-income countries.
The risk of a woman in a developing country dying from a pregnancy-related cause during her lifetime is about 36 times higher compared to a woman living in a developed country.
"To achieve our global goal of improving maternal health and to save women's lives we need to do more to reach those who are most at risk," says Anthony Lake, Executive Director of UNICEF. "That means reaching women in rural areas and poorer households, women from ethnic minorities and indigenous groups..."
Consequently, more needs to be done to reduce this number of deaths. This is a time the government should recognize the role of the health care providers more than ever before especially after they were spread across the country by the twin Health Ministries.
Healthcare providers are the key to any successful maternal health programme but rarely have their views been sought in a structured and dedicated way so as to provide a useful body of evidence about their perspectives on the problems and their solutions.
Midwives, nurses and doctors around the world have a direct voice about the barriers they face in delivering, lifesaving maternal healthcare a strong focus on identifying solutions to longstanding barriers in the delivery of maternal care.
This is because, they understand the way that socio-economic inequality plays out in different settings is important for determining the most effective policy and programme responses to access to health care.
Kenya, like other countries in the world seems to be headed towards an integrated health information system (Kenya Draft Bill and Policy Document 2009). This calls for the development and enhancement of systems and records management for effective collaboration of conventional and traditional medicine sectors.
Of importance is to understand the health indicators in the health information and record management systems which include morbidity indicators, child health indicators, maternal health indictors, supplies indicators and community health care indicators (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).
The Provincial Director, Medical Services in Western Province, Dr. Godrick Onyango, notes that according to the national health indices, 32 per cent of women deliver in hospitals.
To effectively deal with this, the government was urged to support nurses. “The community needs to support nurses for better health”.
However, with these aspects, is it time we thought of new approaches to the whole issue of health to reduce the number of maternal deaths?
Research indicates that if women had access to basic maternal health services, 80 per cent of maternal deaths could be prevented. Vitamin A supplementation, which is readily available per child, could save over a quarter of a million young lives annually by reducing the risk and severity of diarrhea and infections.
Additionally, investment in the health of mothers and children reaps widespread development returns that can benefit communities for generations to come.
The survival and health of mothers is essential to the well-being of the entire family - children who lose their mothers are five times more likely to die in infancy that those who do not.
Healthy children, meanwhile, are more likely to benefit from educational opportunities and grow into productive adults.
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.
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