When Irene Adhiambo felt some labour pains one afternoon, she left her home in Got Rabuor village for a medical check-up at the Homa Bay County Referral Hospital.
Accompanied by her husband Paul Mboya, she walked into the facility with no medical complication, expecting to get hold of their firstborn in a marriage that had already lasted more than 10 years.
After a medical examination, the nurses recommended she be admitted so she could deliver safely.
However, “They said my wife could not get admitted at the facility because all two theatres were busy, despite the fact that she was in labour and the baby had started coming out,” Mboya said.
Instead, after several hours writhing in pain, Adhiambo was referred to Rachuonyo Subcounty Hospital, 70km away.
Sadly, Mboya did not get the chance to hold his long-awaited firstborn. The wife bled to death on the way to the referral hospital for blood transfusion.
NO BLOOD BANK
This is a common occurrence in Homa Bay, where postpartum haemorrhage (excessive bleeding after giving birth) is the leading cause of deaths among delivering women, which is more likely to happen with a caesarean birth.
County Medical Services director Dr Kevin Osuri said the referral hospital still lacks a blood bank that can save the lives of such patients in times of need, despite Homa Bay being the largest blood donor in the larger Nyanza region.
“We are really trying our best to ensure we save every life delivering mothers who may have difficulties while giving birth in our health facilities. However, sometimes we are overwhelmed since we depend on transfusion blood from either Kisumu or Kisii referral hospitals,” he said.
According to the Kenya Demographic Health Survey 2014-15, maternal deaths in Homa Bay stand at 583/100,000 live births, against the national rate of 488/100,000.
Some of the direct medical causes of maternal mortality in Homa Bay include infection, unsafe abortion, hypertensive disorders, obstructed labour ectopic pregnancy, embolism and anaesthesia-related risks.
Fortunately, Osuri said, the county is in its final stage in the construction of the regional blood bank at the County Teaching and Referral Hospital, which is expected to ease the burden even to neighbouring counties.
CRITICAL INTERVENTIONS
Woman representative Gladys Wanga said it is unfortunate that some women are still dying while giving birth.
“Preventing maternal deaths is possible with the existing knowledge and technology,” said Wanga, a former programme manager at LVCT.
She cited preventing unintended pregnancies, monitoring women during pregnancies, and managing medical complications that arise during pregnancy and delivery.
“The four most critical interventions are equipping our medical facilities with modern delivery kits, constructing a blood bank, family planning, antenatal care, skilled delivery and postnatal care, all of which must be expanded and improved to lower cases of maternal mortality,” Wanga said.
She said along with income, education also plays a major role in determining maternal health outcomes, including fertility rates, access to family planning and antenatal coverage.
“Women with higher education are much more likely to receive antenatal care from a medical doctor than those with no education,” she said.
The Medical Services department reports that only a third of pregnant women go to hospital visits for antenatal care, while out of that, only 54 per cent get skilled delivery.
The report further indicates that of the 75 per cent of women who attend the first ANC in Homa Bay, only 31 per cent attend the forth ANC.
“This might actually mean that we might be losing half of the lives at the giving birth stage. Pregnant women must ensure they attend antenatal care sessions and give birth in hospitals,” Wanga said.
She decried the rising number of teenage mothers, most of whom die while giving birth due to various complications.
About 22 women die every day in Kenya due to pregnancy and childbirth-related complications. Worldwide, 70,000 teenage girls die in pregnancy or childbirth every year, making maternal death the most common cause of death in girls between 15 and 19 years of age.
“Delivery at home is still a common practice, and the use of skilled attendance at birth remains low in many places because of cultural reasons and because health facilities are inaccessible or services are perceived to be of poor quality,” Wanga said.
The legislator said emergency services during delivery are necessary to ensure the health of the mother and newborn to avoid maternal deaths.
MORE FUNDING NEEDED
Currently, only 15 per cent of health facilities can provide basic emergency obstetric care in Homa Bay.
Pregnancies in adolescent girls, whose bodies are still growing and developing, put both mothers and babies at risk of negative health consequences.
Nyanza region counties of Homa Bay, Migori, Kisumu and Siaya are among the 15 high burdened counties in maternal and teenage pregnancies.
Wanga promised to ensure funds are allocated to the health sector. She would also seek to enhance legal frameworks to address gender inequality and promote reproductive rights.
The woman representative urged leaders to improve the health infrastructure, rates of skilled birth attendance and access to family planning services.
“We must bring on board all the sectors to wipe out maternal mortality in Homa Bay. We need proper and fully equipped medical facilities, good roads and efficient means of transport for referral cases,” Wanga said.
A report by White Ribbon Alliance, an organisation that advocates affordable and quality health for women, states that 90 per cent of women who die during delivery lose their lives due to poor medical care in hospitals countrywide.
Executive director Angela Nguku said the county government should strengthen the health system and improve quality of healthcare delivery.
“Maternal morbidity and mortality in Kenya results from the interplay of social, cultural, economic and logistical barriers, coupled with a high fertility rate and inadequate and under-funded health service,” she said.
She said since most maternal deaths occur during delivery and during the postpartum period, emergency obstetric care, skilled birth attendants, postpartum care and transportation to medical facilities if complications arise are all necessary components of strategies to reduce maternal mortality.
“The community must also shun cultural beliefs and join the fight, not forgetting the political class,” Nguku said.