Victorine Ndinda/ HANDOUT
Blood type rarely matters for most. It is something we learned in high school biology, memorized long enough to pass an exam, and then forgot. Years later, many of us donated blood for the first time in college and received a small card showing our blood group.
The card sits quietly in a wallet and rarely becomes important until pregnancy. During my first pregnancy, I discovered something that changed how I understood maternal healthcare in Kenya.
I learned that I am Rhesus (Rh) negative; something that came as a shock because my old blood donation card indicated I was A positive.
Rhesus negative blood types are rare. Globally, only about 7 per cent of people are Rh negative.
In Kenya and much of Africa, the number is even smaller, estimated at between 2 and 5 per cent of the population. Being Rh negative may sound unusual but for women, it becomes a serious medical issue during pregnancy as it can develop into rhesus incompatibility.
Rh incompatibility occurs when a mother with Rh-negative blood carries a baby whose blood is Rh positive. When the baby’s blood mixes with the mother’s, usually during delivery, the mother’s body may treat it as a foreign substance and develop antibodies against it.
The first pregnancy is usually safe. But once sensitization happens, future pregnancies can face severe complications including anaemia, jaundice, organ damage or even miscarriage.
The tragedy is that this condition is largely preventable. Doctors manage the risk using an injection called Anti-D immunoglobulin. Rh-negative mothers receive the injection at about 28 weeks of pregnancy and again shortly after delivery.
The medication prevents the mother’s immune system from developing antibodies, protecting future pregnancies. In high-income countries, this treatment is routine.
In many hospitals across Europe and North America, Anti-D injections are standard antenatal care. In many parts of Africa, however, access remains inconsistent.
Studies estimate that although Rh negativity is less common in African populations than in Europe, women in sub-Saharan Africa face up to three times higher reproductive risk because of low screening rates, inconsistent antenatal care and poor access to Anti-D medication.
Kenya is no exception. Roughly 1 to 2 per cent of pregnant women in the country are Rh negative. Without timely Anti-D injections, thousands of pregnancies risk complications that modern medicine has long learned how to prevent.
Maternal health in Kenya is already fragile. According to the Kenya Demographic and Health Survey, the country records about 342 maternal deaths for every 100,000 live births. Many of these deaths are linked not to complex diseases, but to gaps in access to basic maternal care.
While the country has made progress over the years, we are still far from the global target of fewer than 70 deaths per 100,000 births. Preventive care, not just emergency treatment, is what saves lives and that is why the disappearance of something as basic as Anti-D injections matters.
A few years ago, the government introduced the Linda Mama programme under the former National Hospital Insurance Fund (NHIF). The programme provided free maternal services, including antenatal care, delivery and post-natal care in public and accredited private facilities.
For many women, it was a lifeline. When I delivered my second child at a public hospital under the Linda Mama programme, I experienced this support first-hand. As an Rh-negative mother, I needed two Anti-D injections during pregnancy and after delivery.
During my first pregnancy in a private hospital, my partner and I paid nearly Sh12,000 for the injections but under Linda Mama, they were provided free of charge. I remember asking the nurse twice if they were really covered. It felt like the system was finally working for ordinary mothers.
Today, that same injection can cost between Sh6,000 and Sh10,000 in public hospitals, if it is available at all. With the transition from NHIF to the new Social Health Authority and the introduction of the Social Health Insurance Fund, maternal coverage was reorganized under a programme now referred to as Linda Jamii.
On paper, the new system promises broader and more comprehensive coverage. However, the reality on the ground tells a different story.
Unlike Linda Mama which allowed all pregnant women with proof of Kenyan citizenship to access maternal care regardless of their contribution status, the new system largely depends on registration and contributions under the new insurance scheme.
Many vulnerable women remain outside the system. Even more worrying, Anti-D injections that were previously covered are now often unavailable or require out-of-pocket payment. In several public facilities I have personally contacted or visited, the injection was either out of stock or required payment.
Pharmacies quoted prices between Sh10,000 and Sh11,000 when it was available. For many Kenyan families, that cost is simply unaffordable.
The consequences extend far beyond a single pregnancy. Once a woman becomes sensitised, the antibodies remain in her body for life. Future pregnancies carry higher risks, and the emotional burden can be devastating.
Repeated miscarriages, complications in newborns and unexplained pregnancy losses can cause grief, financial strain and even social stigma.
In many communities, women often carry the blame for pregnancy complications that are actually medical conditions. This is why access to Anti-D injections is not a luxury; it is a basic maternal health necessity.
At the same time, troubling allegations of financial mismanagement and graft within the new health financing system have raised serious public concerns.
If billions of shillings are flowing into the system, Kenyans are right to ask why essential medicines like Anti-D are disappearing from public hospitals.
Maternal health is not measured by policy announcements or renamed programmes. It is measured by whether a pregnant woman receives the care she needs when she needs it without financial hardship.
Kenya cannot claim to be strengthening maternal healthcare while basic preventive treatments quietly disappear and become unaffordable. If the government is serious about improving maternal outcomes, then lifesaving interventions such as Anti-D injections must be consistently available and fully covered in public facilities.
A country that once provided this medication free of charge should not allow it to become a rare commodity.
If we are serious about safe motherhood, restoring universal access to Anti-D is urgent. For Rh-negative mothers across the country, the difference between access and inaccessibility is not a bureaucratic policy debate. It is the difference between safe pregnancies and preventable heartbreak. And that is a price Kenyan families should never have to pay.
Victorine Ndinda is a Kenyan Health Systems Strengthening advocate with over a decade of experience designing and managing integrated health programmes across Kenya.
