By Elizabeth Mwai

Ndinda Nzioki chuckles as her lovely baby girl, Grace, impatiently wrestles with her breast.

The mother of two gently brushes away the tiny fingers and swiftly flips her blouse open to help little Grace suckle.

Nzioki winces as her daughter sinks her gums into her breast, biting her in the process. But Grace settles soon after and suckles breathlessly.

"She has such an appetite and I cannot refuse her otherwise she will cry her heart out," Nzioki explains.

Baby Grace pensively watches as a doctor takes her weight in Kibera. [PHOTOS: TABITHA OTWORI /STANDARD]

Grace is 10 months old, and she is lucky to be alive, after surviving a home delivery that nearly went awry.

Nzioki, 24, lives in Soweto Village, Kibera, where women must return to their homes before nightfall for fear of criminals.

So insecure are the alleys of Soweto that even a pregnant woman wailing with labour pains will not be spared by thieves.

So when Nzioki’s moment came, she was unable to get to the hospital for fear of attack and had to deliver at home.

Nzioki’s situation is not unique. According to the African Population and Health Research Centre (APHRC) slum areas have a maternal death rate of 706 deaths per 100,000 live births, which is higher than the national average of 414 deaths per 100,000 live births.

Speaking at a city hotel to mark World Health Organisations World Health Day, which was themed ‘Urbanisation and Health,’ doctors expressed fears over rising mortality rates in informal settlements.

"The reasons why women are dying in large numbers are known but we are not addressing them adequately," says Dr Francis Kimani, the director of Medical Service at the Ministry of Health, adding: "We have research information on maternal health pending in 29 districts but it has not been implemented. To address the situation, we need to take aggressive and robust measures that cut across all Government ministries."

Dr Kimani says some of the reasons prompting home delivery are petty, such as men’s belief that women have to prove they are strong enough to endure birth pains.

But the women’s major worries include insecurity and poor infrastructure that prevent easy access to slums by ambulances in case of medical emergencies.

Nzioki says many women in Kibera also prefer to deliver at home because it is cheaper and the traditional birth attendants can be paid long after the child is born.

Such a birth attendant will charge Sh1, 000 but they can be paid in small amounts until the debt is cleared.

The mother of two has seen the traditional birth attendants deliver many babies in the informal settlement but confesses that some women have died in the process.

"There are so many women who die and the husbands get other women and take care the children of the dead spouses. They take them to their rural homes to suffer," said Nzioki.

Nzioki says her 20-year-old neighbour died three years ago while giving birth to her fifth child. "The placenta remained inside and the traditional birth attendant was not able to remove it, so she bled to death," said Nzioki.

The medical officer in charge of Kibera Community Health Centre, Dr Marjory Waweru, warns about the dangers of home deliver.

She cites statistics from the Ministry of Health showing that 55 per cent of women who deliver at home are under unskilled care.

"Some of the children at the Amref facility with eye and umbilical cord infections acquired them from the unhygienic conditions in which they were delivered," says Waweru, adding that some children have other physical and congenital malformations but parents do not always seek treatment.

BALANCING ACT: Ndinda Nzioki prepares a meal at her Kibera home. [PHOTO: TABITHA ATWORI/STANDARD]

Medics and researchers expressed fears that slums are not just assailed by maternal mortality alone; other health concerns also exist.

Speaking at the World Health Day, APRHC Executive Director Dr Alex Ezeh said urban poor, mostly living in informal settlements, and accounting to 70% of city dwellers, have no access to quality healthcare.

"This has been caused by rapid urbanisation and inequities in distribution of health services provisions," Ezeh said, warning of a health crisis due to increased rural to urban migration, which is exacerbating communicable diseases.

"One in three children get diarrhoea in the first or second week of birth which can be fatal," Ezeh added.