When a woman dies from pregnancy or childbirth, it is not just a personal tragedy, but proof of how shamefully little many countries have done to tackle maternal mortality.
Maternal health will be high up on the agenda at the Millennium Development Goals summit.
The goal of improving maternal health — with the targets of reducing by three-quarters the maternal mortality ratio between 1990 and 2015 and achieving universal access to reproductive health by 2015 — has seen little progress, especially in sub-Saharan Africa, where one in 31 women die during childbirth compared to one in 4,300 in the developed world.
Data released this week by the United Nations and the World Bank says that 11 countries, including Kenya, comprised 65 per cent of all maternal deaths in 2008.
As I consider the progress on reproductive health and high rates of maternal deaths in Kenya, which is 15 per cent of all deaths for women of reproductive age, I am reminded of 30-year-old Beatrice N., whose story sheds light on what ails health care in Kenya.
In an interview last year, she told me: “I felt some pains early in the morning. By evening, the pains were still mild so I went to bed.
Around 1am, the pain became severe, but we had to wait until morning to go to the dispensary because it was raining and the road was bad.
We arrived at the dispensary the following morning at around 8am. The nurse examined me and said labour was progressing well and I would deliver by noon.”
The nurse was alone at the dispensary, and left Beatrice unattended for long periods to attend to other patients.
“By 4pm, I had not delivered and I was in severe pain. The nurse said she could not help me and asked my mother to take me to the district hospital. There was no ambulance. Finally, we arrived at the hospital at 10pm. The baby was dead. They operated on me to remove it. Later I discovered I could not control urine.”
The availability, quality, comprehensiveness, and utilisation of health services, including maternity services, depend in part on the number of health workers at a facility.
Kenyan health services, like those in many other countries in sub-Saharan Africa, suffer from longstanding human resource shortages and insufficient health facilities, especially in rural areas.
These issues have a direct impact on maternal health. An adequately resourced, equitable, and integrated health system is needed to ensure that women have healthy pregnancies and get help when they face emergencies.
Too few facilities in Kenya offer normal delivery services. Even fewer provide emergency obstetric care that could save women’s lives.
In December 2009, I visited dispensaries and hospitals in four Kenyan provinces. At some dispensaries, there were long queues of men and women and children waiting to see the only nurse.
At one district hospital, a nurse in the gynaecology ward had to ask a nurse from another ward to help give patients medicine because she was alone with about 40 patients.
The challenges facing the government are a good illustration of the challenges facing many countries in the region. The government has been grappling with how to reduce maternal mortality and morbidity, and has many fine policies on paper. But the reality is far from the vision.
As international technical and financial assistance is stepped up to achieve the MDGs, the government should act more aggressively to improve its health system.
It has made tentative steps to deal with human resource shortages, but it needs to do more to ensure there are enough qualified health workers, including midwives, whose services can be made available throughout the country.
The government should finalise its strategy for patient referrals between health facilities and put it into operation, with a focus on marginalised regions.
Maternal death is not inevitable. Women have a right to life-saving care. It is inexcusable for any government to allow so many women to suffer preventable deaths.
Kenya should seize the moment and the expected international assistance that will flow from the summit to transform its health system.
Ms Odhiambo is a women’s rights researcher with Human Rights Watch, Nairobi ([email protected]).