Saving mothers saves money

Selina Mwende walked ahead of her husband as she came from work and headed straight to the bathroom.

Minutes later she was staring at a nightmare. The little stick she had brought from the pharmacy turned blue, confirming her fears; she was pregnant again. For next 20 minutes, she sat on the toilet seat in a trance, not knowing what to do, think or feel.

Images from the past crossed her mind. She remembered how excited her husband was when she announced their first and second pregnancies.

“But he had accusingly stared at me when I broke the news of the third pregnancy. How would he take this fourth one?” she had shaken with fear and uncertainty.

Four out of every ten women in Kenya find themselves in a similar situation because they cannot avoid getting pregnant because they do not use any effective contraceptive method.

Unplanned as they are, many of those pregnancies also have dire health consequences. Each year, 183,000 women in sub-Saharan Africa - enough to fill Nairobi’s Nyayo National Stadium six times over – die from preventable pregnancy-related illnesses.

In Kenya, 15 counties carry the biggest burden of maternal deaths. They are Marsabit, Mandera, Wajir, Lamu, Migori, Garissa, Kisumu, Homa Bay, Turkana, Taita Taveta, Kakamega, Nakuru, Nairobi, Isiolo and Siaya.

While the maternal mortality rate (MMR) is 488 deaths per 100,000 live births in Kenya, remote areas fare much worse: Mandera and Wajir have a staggering rate of 3,795 and 1,683 respectively, higher than wartime Afghanistan or Somalia.

The Ministry of Health and UNFPA are working with the affected counties, whose governors have already signed a commitment to allocate more resources towards reducing maternal and new-born deaths.

The initiative also includes engaging leaders of faith-based institutions to push for greater attention to maternal and child survival programmes.

Experts now say Kenya is one of the developing countries that could increase by up to four times the money available for social programmes such as education, immunisation, water and sanitation, if they spent a little more on sexual and reproductive health programmes.

For instance, while in 2010 the country spent about Sh17 billion on reproductive health, an expert analysis done in 2011 estimated that an additional Sh5.3 billion spent on family planning could have resulted in a saving of Sh20.3 billion.

This would have included Sh8.6 billion for education, 2.8 billion for immunisation, Sh2.7 billion for water and sanitation, Sh5.6 for maternal health and Sh0.6 billion for malaria.

The report, funded by UNFPA, UKAid and the Bill and Melinda Gates Foundation and carried out by the Guttmacher Institute, says that if all unmet needs for modern contraception were satisfied, unintended pregnancies would drop by 83 per cent per year and unsafe abortions by 84 per cent.

Kenya’s Health ministry says that seven out of every ten women who seek post-abortion care are not using any method of contraception prior to becoming pregnant.

The Guttmacher report, titled Adding It Up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014, indicates that services still fall short of needs in developing countries.

Most maternal deaths are due to causes directly related to pregnancy and childbirth, unsafe abortion and obstetric complications such as severe bleeding, infection, hypertensive disorders, and obstructed labour.

Others are due to causes such as malaria, diabetes, hepatitis, and anaemia, which are aggravated by pregnancy.

Limited access to and inadequate utilisation of essential health services are also to blame.