In a small village in Tseikuru, Kitui, Joyce Makasi holds her daughter Charity Kaluki who she named after the county’s governor. Joyce delivered Baby Charity at Tseikuru Level 4 Hospital on the day the governor opened the facility for operations.
But this is not the most fascinating thing about the baby and her mother. Instead, it is how these two would not have lived had it not been for conversations between Joyce and other pregnant women with health workers in a health centre near Joyce’s home.
Joyce and other women gather to walk to the hospital together, laughing and chatting, for their antenatal care. In an expansive county like Kitui, encouraging women to go to the facility together has made a difference.
Antenatal care is one of the tools that can unburden communities of the heartbreak of losing mothers and their children during pregnancy, delivery and immediately after delivery.
When women attend antenatal care clinics, health workers run several tests throughout the visits. Should they detect any challenge such as hypertension, they will provide interventions for the mother and her unborn child throughout the duration of pregnancy.
However, studies have shown that many factors, such as lack of transport to health facilities far away from home, can discourage women from attending antenatal clinics. Sometimes, out of exhaustion and busy life, the mothers can forget their appointments.
This is where Group Antenatal Care saves the day. Group Antenatal Care also takes place at the health facility and is offered to women as a group, not one-on-one as the individual ANC.
Research shows that Group Antenatal Care, where women learn about social and clinical care that goes into a pregnancy, has reduced maternal and child deaths in Kenya and Nigeria.
Kitui does not run a formal GANC but Ruth Kilonzo, deputy head of Maternal and Reproductive Health Division in the county, said she observed an increase in attendance to ANC when the county piloted the service in certain wards.
During her third visit to the health facility, the clinician raised the alarm about Joyce’s malnutrition, anaemia and potential high blood pressure. During her fourth visit, she got her individual birth plan from the clinic and she knew that she would have to deliver in a hospital that could operate on her and not the health centre that was close to her.
When she went into labour, the family rushed her to Tseikuru Level 4 Hospital, a journey that protected her from the many dangers that kill a mother and her child, like bleeding excessively during and after delivery, pregnancy-induced blood pressure and other life-threatening complications.
In her conversations, Joyce can cite women with whom she attended clinics who had other medical challenges that health workers detected and planned for. For Joyce, the intervention was delivering through surgery. For other women, it was a change in nutrition or managing their weight.
Kenya’s Maternal Mortality Ratio is still unacceptably high, at 362 deaths per 100,000 live births, and a stillbirth rate of 23 per 1,000 live births, as recorded in the Kenya Demographic Health Survey. This is far below the Ministry of Health’s target of 147 maternal mortality per 100,000 live births and 12 stillbirths per 1,000 live births. Generally, more than 6,000 maternal deaths and 35,000 stillbirths occur each year.
ANC would prevent a majority of the deaths but many women experience other social challenges that eventually affect their health-seeking behaviours and the overall health of the baby. When they are together, in Group Antenatal Care, they are each other’s support systems, increasing their resilience. It is fascinating to watch GANC sessions in Kitui.
Group Antenatal Care appeals to the most natural traits of African rural areas: Telling stories and being one another’s keeper. In the new National Guidelines on Quality Obstetrics and Perinatal Care, the Ministry of Health has incorporated Group Antenatal Care detailing what women expect from the first to the eighth and last time they visit the facility.
In the first clinic contact, the health worker group the mothers in the same gestation period and gives them important lessons such as the danger signs in pregnancy, and why it is recommended that they deliver in health facilities under the care of a trained health worker.
GANC is not the solution to the high maternal mortality in Kenya. The county health departments must ensure that hospitals are well equipped and staffed so that when the women come to deliver, they get quality care.
The number of health facilities has almost doubled in the last decade alone. The Kenya Health Workforce Report that the Ministry of Health released in 2019 also cites a doubling of almost all cadres of health workers. However, even in their numbers and the best equipment, health workers may not arrest health challenges diagnosed late—on the delivery day.
As we head to the ballot box, ask your MCA if they understand the key issues affecting women in your area. Ask them how they plan to address those issues in budgetary allocations.
Medical doctor, public health specialist and Kenya country director for John Hopkins affiliate, Jhpiego
