Role of legislation and policy formulation in advancing maternal health

The time for Baby Matthew’s birth came suddenly after a few hours of labour, and it took us all by surprise. Well, except for the mother, who was eager to receive her second child.

Though in the adjacent room, I was lucky enough to witness the first cry, which was not only heavenly but also a high score on the Apgar score chart, which is used to assess the health condition of newborns after delivery. This experience got me thinking of maternal health and its role as an indicator of progress towards achieving Universal Health Coverage for any given country, most especially for countries in sub-Saharan Africa.

Maternal health is defined by the World Health Organisation (WHO) as the health service provided to women during pregnancy, childbirth and the postpartum period. In this regard, this care incorporates access to pre-pregnancy services, pregnancy services, labour and delivery services through to the postpartum care services. By strengthening maternal healthcare, mothers are able to get a fulfilling experience during pregnancy and after delivery, and maternal deaths are reduced significantly.

Going by the latest fact sheet on maternal mortality released by WHO on September 19, about 830 women die every day from preventable causes related to pregnancy and childbirth. Low and lower-middle-income countries contribute to 94 per cent of these deaths. Sub-Saharan Africa alone contributes to about 196,000, which amounts to two-thirds of the maternal deaths.

Women lose their lives as a result of complications [most of which are preventable or treatable] that arise during pregnancy and after childbirth. There are major complications that account for about 75 per cent of all maternal deaths, which include severe bleeding, infections, high blood pressure, complications from delivery and unsafe abortion.

Severe bleeding, also known as postpartum hemorrhage, is responsible for 27 per cent of maternal deaths globally and is likely to happen to 1 in about 100 to 5 in about 100 women. As a way of stirring a sufficient, safe and sustainable supply of blood for Africa’s mothers, the Organisation of African First Ladies Development (OAFLAD) and Terumo BCT, a global leader in advancing blood safety for those in need, convened for a call-to-action panel on September 25 on the importance of safe blood supply for Africa’s mothers.

A Policy Brief released in June 2015 showed that nearly 6,300 women lose their lives annually during pregnancy and childbirth. Kenya fell short of achieving the Millennial Development Goal 5: improving maternal mortality by 75 per cent. Maternal mortality remained at 400-600 deaths per 100,000 live births between 2003 and 2015 thus the country fell short of the targeted 147 deaths per 100,000 livebirths.

Travelling for long distances to access health facilities and skilled delivery services are some of the challenges being faced by expectant women in Kenya. Actually, data provided in 2017 by Confidential Enquiry into Maternal Deaths in Kenya shows that 9 out of 10 women who died in 2017 from pregnancy related causes were as a result of sub-standard care and at the same time 73% of these deaths occurred outside working hours. There is need to strengthen policy and political support for maternal health as a way of addressing these challenges being faced by women during pregnancy and child birth.

Pregnancy is such a critical period for women and their children and during this time, they require a lot of care and it is correct to say that the legislators must have considered this fact when they enshrined the right to the highest attainable standard of health while formulating the highest law of the land, the Constitution of Kenya 2010.

But there is still hope for the country, same way the government introduced free maternity services back in the year 2013, an initiative that led to an increase of about 10 per cent of deliveries within health facilities across the country, different counties are coming up with their own initiatives to improve maternal health. For instance, the Frontier Counties of Kenya, have formed a Sector Forum for Health for, inter alia, accelerating progress towards better maternal health outcomes in these counties.

Makueni county, on the other hand, proposed a Maternal, Newborn and Child Health legislation in 2017 which was the first of its kind in the country with an aim of safeguarding the provision of quality healthcare to women during pregnancy, at birth and care of the newborns after delivery.

We need to keep coming up with more initiatives while building on the already existing ones, and formulate requisite legislation and policies so as to create a safe country for women as they bring their newborns into the world.