Reducing Maternal Mortality in Kenya

Nairobi, Kenya:

The Kenyan Ministry of Public Health and Sanitation and USAID-funded APHIAplus KAMILI have partnered to develop a pilot project to help pregnant women seek antenatal care and delivery services using their mobile phones.

Pregnant women have increasingly been opting to deliver at home, seeking the help of traditional birth attendants. According to a 2010 survey by the Kenya Service Provision Assessment, an estimated 56% of pregnant women deliver at home, most without assistance from a trained provider. This trend is in part responsible for Kenya’s high maternal mortality rate which is thought to be approximately 530 per 100,000 live births, one of the highest in the world.

Jahonga Ruth, Reproductive Health Advisor with APHIAplus KAMILI, explained to Think Africa Press that most of the women who die in pregnancy do so due to complications such as haemorrhages, obstructed labour, hypertensive disease, sepsis and ruptured uterus. “We want to ensure that the lives of both the mother and the child are safeguarded,” she said.

Ruth described how the mobile-phone project – being piloted in the town of Matuu, in Machakos County – will ensure that pregnant women in the area are registered by health-providers who will always call or send an SMS text to patients to check their conditions are stable. “Using the SMS platform, the mothers can be reminded to attend antenatal care, and even make individual birth plans,” she explained. The project also supports midwives with relevant information and updates as well as giving them airtime to call mothers to arrange follow up care.

“Poverty levels are high in most of the informal settlements and some of the women cannot even afford to call the health providers for assistance” she said.

Changing perceptions

Louisa Muteti, Provincial Reproductive Health Coordinator for Eastern Province, told Think Africa Press that the pregnant women who deliver at home tend to do so due to lack of transport and negative perceptions about the health providers in public hospitals.

She said: “We have received many complaints about the harsh treatment pregnant women undergo from nurses – we need to change that perception.”

Since the start of the pilot project, the health service has been attending to at least 50 women per month, a number that is increasing. “The response is so positive and the women have started gaining trust in our services, securing the life of the child and the mother” Muteti explained.

“We are encouraging most pregnant women to seek professional help when it comes to medical attention. Traditional birth attendants in most cases cannot help during emergency,” she posed. She believes that pregnant women will benefit from the project, and even reduce most of the child deaths that occur during home birth delivery.

Traditional birth attendants

Some, however, see traditional birth attendants as part of the solution to the project of improving Kenya’s maternal mortality rate rather than merely a hindrance.

Florence Nekesa, a traditional birth attendant explained that most of the young women who seek her assistance do so because they fear the mandatory HIV tests required in some of the health facilities in the country, but insisted that she is responsible in her treatment and advice.

“I always insist on the clinic card before I perform any duty. In case there is a problem, I advise the young girls to seek further medical attention”, she said.

The mother-of-five added that most of her clients visit her sometimes for stomach massage purposes, later giving birth at the nearby health centres. “Not so many women are informed about the importance of the baby’s positioning” she remarked, explaining that nurses at regular clinics often only check the heartbeat of the child instead of massaging the pregnant woman. “Massages allow free movement of the child inside the womb and also reduce pain. Most women cannot even realise if the baby is moving or not.”

Nekesa said that she has been in the business for at least 28 years and has never encountered serious birth complications. “In a month I can attend to at least six people and I have never encountered any serious challenges apart from over bleeding”.

“I always make sure that I do not reuse the same blade during delivery and I use a lot of detergents to clean the place for the next delivery service,” she added.

Nekesa has been urging the Ministry of Health to support traditional birth attendants through training and even to recognise their work since, she claims, some of the traditional birth attendants work better than the nurses at the hospitals.

“My good work is known and respected by many people around here, for the nurses, they still believe that we are just quacks who are exploiting pregnant women”.

Whether by using traditional birth attendants or simply by increasing ease of access to trained midwives, it is urgent and imperative that Kenya’s health ministry tackle its maternal mortality rate. Using technology to make contacting healthcare providers cheaper and easier may be one important first step.

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