Maternal Health Challenges in Kenya – What Research Evidence Shows.

July 12th 2011

The African Population and Health Research Centre (APHRC) and the Woodrow Wilson Centre – Washington-DC organised a two- day workshop that was aimed at improving stakeholders ‘dialogue on Maternal Health in Kenya’. The first day’sagendas were to strengthen the dialogue between experts, to discuss research results and to compile recommendations for further investigations. The second day addressed the public on outcomes of the same.

I will make referenceto the first day:

After the welcoming remarks and a round of introduction the workshop started with an overview of what new research showsby Geoffrey Mumia. He elaborated that although Kenya’s Government drew up the National Reproductive Health Strategy (NRHS,1997-2010),after the International Conference on Population and Development (ICPD) in Cairo(1994), which focuses on access to quality maternal and child care and utilization of quality and cost effective maternal child health (MCH) services,many life-threatening pregnancy-related complications and subsequent poor outcomes for women and new-borns still occur.,

It is estimated that there are 488 maternal deaths per 100,000 live births in Kenya (KNBS and ICF Macro, 2010). SOme of the challenges faced include:

  • There are only 260 qualified paediatricians in Kenya, out of whom 170 operate in Nairobi.
  • Lack of sufficient skills for quality reproductive health services
  • Lack of access to preventive interventions, early diagnosis, treatment and emergency care, and
  • In spite of the critical role of emergency obstetric care, very few facilities in Kenya are equipped to offer this service.

Following the introduction three presentations were shown:

  1. State of Maternal Health in Rural Context by Dr. Lawrence Ikamari, Director, Population Studies&Research Institute
  2. State of Maternal Health in Urban Context by Cathrine Kyobutungi, Director of Health Systems & Challenges, APHRC
  3. Gender and Maternal Health by Dr. Margaret Meme

Dr. Lawrence Ikamari pointed out that Kenya is a rural Country given majority of the Kenyan population live in rural areas (3/4). The situation is especially critical for women as childbearing starts early hence fertility rates, especially in rural areas, is still high as well as maternal-mortality ratesof52 per 1000pregnant mothers. Additionally, child mortality shows that out of 1000 children,25 are dying in rural areas in comparison to 16 in urban settlements.

Antenatal (ANC) care is taken up only by few pregnant women, 63.3% deliver at home. Main reasons for the low uptake were mentioned as:

  • Health facilities are too far / no transport / insecurity
  • Many feel it is not necessary to deliver in a health facility
  • Delivery occurs too fast
  • Unfriendly health staff
  • The costs are too high

This indicates that apart from the fact that the fertility rate is quite high in rural areas, the access to safe motherhood services is extremely limited. It was further more pointed out that there is a lack of obstetric care, lack of ability of service providers and lack of family planning.

Cathrine Kyobutungi strressed in her presentation the need for better access to family planning and safe abortion, skilled health professionals, betteraccess to health facilities and good referral systems.

She also mentioned intra-urban disparities in the way that there are close similarities between rural and urban slum situations. Transport to the facilities is one of the main concerns for pregnant women when they think of whether or not to deliver in a health facility consequently explaining the need for nursery homes, as there are insecurities involved in delivering at night and taking public transport. ANC is used around 54% in rural as well as in urban-slum areas.

The relation between Gender and Maternal health was brought up by Ms. Meme. She stated that around 8, 000 maternal mortalities occur within a year in Kenya and nobody is talking about them. She compared thid to the 3, 000 people who died after the 9/ 11 attacks,the 4, 000 soldiers who died in the war in Iraq. It takes 200days (6 months) to mourning our mothers.

She also stressed that ‘gender’ also involves men. Duties of men must be taken more into consideration. When it comes to safe motherhood, most programmes target clinical services.However, social gender, cultural aspects, human rights, economic factors and tasks of men have been ignored. She strongly recommends looking cross countries’ best practises, male involvement, the creation of a bill to protect pregnant women and stressed the multi-sectoral accountability. We have to shift health, pregnancy and death from private to public.

Three working groups were formed to elaborate recommendations. Some of the outputs were:

  • We do notneed more policies, we have enough.However, more enactment is required
  • Political will (politicians should support more as they were brought up on the grass-root, so they know and can talk about)
  • Involve men in awareness raising
  • More clarity on user fee. There is a confusion on what is paid, where and when
  • Motivation for health workers should be forced on, since they are overloaded (looking into performance and incentives)
  • Integration of different services meaning, integration of Human Rights, maternal health and HIV and AIDS, to reduce stigma.
  • More financial supply from Government
  • Health facilities must be better equipped
  • Other sectors must be involved:
  • transport / roads
  • Agriculture (mothers need food for breast feeding …)
  • Communication / technology (for media adverts..)
  • Legal framework (need to bring in right based approaches
  • Multi- sectoral planning which includes Ministries of Planning, Finance, Gender
  • Ministry of Education must also be involved
  • Implementation of a referral system

And finally a major concern was mentioned on the current user unfriendly services. Health personnel must be trained and motivated to be user friendly. Medical Doctors could learn a lot from traditional birth attendants. Cooperation is recommended.

The first day ended with a video conference between Kenya and Washington DC.

Author: Dr. Carmen Humboldt, Programme Manager Health Development Service