Woman dies at home despite free maternity care

By MERCY KAHENDA and LAWRENCE ALURU

The waiver of maternity fees in public hospitals has seen an increase in women seeking the services.

However, some families keen to avoid other costs associated with visiting a hospital – such as transport – are still staying away.

Last week, journalists in Nakuru County covered the heartbreaking story of a woman who died while being assisted to give birth by her husband in Chebitet village. Instead of calling a midwife or rushing his wife to a hospital, the man chose to assist her at home despite having no experience in helping to deliver a baby.

The woman died due to excessive bleeding hours after giving birth to a healthy baby. Residents said majority of pregnant women seek help from midwives at a cost of Sh1,000 because hospitals are far away and lack equipment.

The nearest public hospital that offer offers maternity care is Njoro health centre, located 15km away from the village.

The maternity fees waiver, which became effective following a directive by President Uhuru Kenyatta on Madaraka Day, is aimed at reducing maternal mortality. In parts of Rift Valley, this has seen women who would have given birth at home due of financial constrains go to public hospitals.

Immediately after the directive, mothers who had been detained for maternal bills were discharged.

Ms Sylvia Wanjiku, the mother of a two-month-old baby, said she had been forced to stay in a hospital for failing to clear maternity bill.

By the time she was discharged, her bill had accumulated to more than Sh20,000. She lauds the Government for the fees waiver saying she could not have raised money to clear the bill as her husband does casual jobs which fetch little money.

“I had been at the hospital for more than two months yet bills kept increasing,” said Wanjiku.

She says free maternity services allow mothers to join their families immediately after delivery.

“Staying in a hospital after delivery due to lack of finances is frustrating,” she says. “(Detained) Women lack love from their families despite having brought a new child to the world.”

New nurses

According to Njoro health centre deputy nursing officer Jacinata Gechia, the facility has recorded an increase of pregnant mothers seeking maternity services.

“Women are happy because immediately after delivery, they are allowed to join their families,” says Gechia. She says in June, the hospital recorded 710 pregnant women, a slight increase from 668 in May before introduction of the waiver while July recorded 773. She says the hospital received five new nurses after introduction of free maternity care.

“The Government employed five nurses after the roll out of free maternity services,” says Ms Gechia.

The nurse said free maternal care would reduce number of deaths caused by birth complications as immediate attention is provided by nurses during delivery in hospitals.

“During labour, most women are attended to by untrained midwives and they only report to hospital when they experience complications. Free attention has increased number of attendance,” she adds.

She says facilities at the hospital are adequate to ensure efficient service delivery. Despite provision of free maternity services in all government hospitals, some pregnant mothers are still giving birth at home.

“(Some) pregnant women prefer being attended to by midwives during child birth because it takes too long for them to (travel to the nearest) public hospitals which are congested,” says Mary Chebet, referring to the Chebitet incident. While there are private hospitals in the area, most charge between Sh2,000 and Sh3,000, which majority of residents cannot afford.

According to United Nations maternal report released last year, in every two minutes, a woman dies of pregnancy related complications, the four most common causes being excessive bleeding after birth, infections and high blood pressure during pregnancy. The report says that 99 per cent of maternal deaths that occur in developing countries can be prevented.

Meanwhile, the Siaya District Hospital has seen a surge in the number of women seeking maternity services since the fees waiver.

The mothers also prefer the facility instead of other sub-district hospitals and health centres in the county. Doctors have urged the Government to increase the number of nurses in the hospital to cope with swelling numbers in the maternity wing.

County Medical Director Jackson Kioko says hospital births were very low before the Government waived maternity fees in June. Initially, only five mothers gave birth at the facility per day: This has risen to 180 daily.

Dr Kioko expects the numbers to rise in coming months as the number of women attending antenatal clinics has doubled.

“We expect huge numbers but we are sure other sub-district hospitals and health centres in the county will help to contain the numbers,” Kioko told The Standard On Saturday. He however, says Siaya District Hospital, which as the county’s referral facility, needs better equipment.

Though the County Government will decentralise health provision, Siaya remains central to all health centres. The hospital plans to request the Government to employ more medical practitioners to enhance service delivery.

Equipment

While reproductive health has received much attention, maternal health which is also critical needs concerted efforts to improve the sector. But Kioko is optimistic the hospital will handle the rising demand for maternal services.

“Teething problems are evident when new structures are taking shape,” he adds. “(At the moment) everything seems new causing mistakes to be made.”

The Government allocated Sh31.6 billion to the health docket, with Sh3.8 billion going towards financing free maternity services.

The hospital also gives sanitary towels to mothers. But caesarean section surgeries are bound to face severe challenges if the issues of medical equipment and staff are not addressed. Apart from human resource, medical supplies also need to be addressed to ensure smooth operations.

However, Kioko says the Government refunds supplies for maternity whenever the hospital purchases.

Across the 47 counties, Kenyans are counting on the government to expand medical facilities to ensure they benefit from the free maternity services. The free maternity care is expected to reduce mother and child mortality. A study carried out four years ago by Kenya Service Provision Assessment Survey, catalogues the inequalities in maternal healthcare across the country that leaves women in rural areas vulnerable in an emergency.

But this is expected to change soon if the services are streamlined in all hospitals and health centres.