Midwives on the edge: Holding the thin line between life and death

The voices of elderly Endorois women rose softly into the dry afternoon wind outside the newly opened maternity unit at Kapkuikui Dispensary in Baringo South.

Dressed in bright traditional regalia, they swayed and danced under the scorching sun as young mothers clapped nearby and children watched curiously from the edge of the gathering. Their song drifted across the rocky hills in celebration.

But beneath the joy lay memories of years of hardship, women forced to travel long, dangerous distances while in labour, delayed referrals and countless births taking place far from skilled medical care.

For the first time in 13 years, mothers in this corner of Baringo will no longer have to make exhausting journeys to Marigat or Kabarnet in search of maternity services.

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“Kii Boyboen raani chepyosoi, Makebendi achek Marigat, kaketekwekwech maternity en yue, mito yue,” the women sang joyfully in Endorois.

Translated, the song means: “We are happy mothers today, we are no longer going to Marigat, now we have maternity services nearby, right here with us.”

The celebration, held during International Midwives Week under the global theme One Million More Midwives, marked the official opening of the long-awaited maternity unit.

Residents described the development not just as progress, but as survival brought closer to home.

“Kimeche achek kesich lagoik kochomogei, kimoche achek kenyit nursery,” an elderly soloist sang softly.

Translated, it means: We want our children to deliver safely, we want nursery schools to be filled again.

To an outsider, it may have sounded like an ordinary village celebration.

But in this vast remote frontier of Kenya, where roads disappear into dry valleys and health facilities lie hours apart, a maternity unit is often the difference between life and death.

At the center of that fragile line are overstretched midwives, emotionally drained and working across harsh terrain. Beyond Kapkuikui lies a harsher reality in Baringo’s interior. In Tiaty Sub County, childbirth remains a race against distance.

Settlements are scattered across dry escarpments and valleys. Mothers walk for hours to reach roads, others face over 100 kilometres to skilled care.
Insecurity linked to cattle rustling worsens the situation.

Inside Chemolingot Sub-county Hospital, nurse manager Anderson Kimechwa is accustomed to these realities.

“Tiaty covers almost half of Baringo and remains the most remote,” he says.

Many arrive late, others attempt delivery with traditional birth attendants before referral.

“By the time they reach here we are trying to save lives,” he says.

He recalls a case where a mother arrived after a failed home delivery, bleeding heavily, baby distressed.

“She had an episiotomy in the village. We stabilised the baby but saving the mother became difficult,” he says. Her blood type was rare rhesus negative and no blood was available in Baringo.

A unit was found in Naivasha, but insecurity blocked transport. The road was impassable.

Inside the ward, staff used a Non-Pneumatic Anti-Shock Garment to stabilise her.

Blood was ferried from Naivasha to Marigat then by boda boda to Chemolingot through rough terrain.

For 48 hours, survival depended on improvisation.

Across Baringo, maternal healthcare exists in two realities.

KHIS data shows skilled birth attendance stagnating around 60 percent over four years: 62.7 in 2022, 64.8 in 2023, 62.1 in 2024 and 60.9 in 2025.

Nearly four in ten mothers deliver without skilled care. In Marigat, Koibatek and Baringo Central over 80 percent deliver in facilities. In Tiaty East, Tiaty West and Baringo North, barely one in three do.

Outcomes depend more on geography than biology. Out of 20,000 pregnancies in 2025, fewer than 2,000 attended antenatal care in the first trimester. Only 825 completed WHO recommended eight visits. In Tiaty only 49 did. Poverty, insecurity and distance delay care.

“The crisis begins months before labour,” says Kimechwa. Anaemia and hypertension go undetected. Babies arrive distressed. In 2025 there were 57 neonatal deaths.

“In such cases saving mother and baby are separate battles,” he says.

Mercy Chemenjo nearly died from postpartum haemorrhage at Atiar Dispensary. “I felt my strength leaving me,” she recalls. A NASG stabilised her before referral.

“If I delivered at home I would be dead,” she says.

The shortage of midwives worsens outcomes.

Emmy Kibet says only about three are fully trained in Baringo. “Maternity is seen as punishment but it is where life begins,” she says.

Some facilities have one health worker overnight.

Deaths follow staff home emotionally. A mother arrived at 3am with a dead baby in womb. She later survived surgery.

“She had haemoglobin of five,” she says. Midwives Week highlighted global shortages.

Emmy calls for specialised training colleges.

Traditional birth attendants remain trusted.

Harun Karanja says they should be referral partners. “We work with them not against them,” he says.

Dandelion Africa has trained workers and supplied NASG kits.

But staffing remains a challenge.

“A mother may arrive at night and find no one,” he says. System strengthening is needed.

Woman Rep Florence Jematia recalls her own birth.

“I was delivered by a traditional birth attendant,” she says. She supports cultural practices alongside safe care.

“This maternity unit will save lives,” she says.
But facilities must match skilled staff.

Health infrastructure expansion in rural Baringo is expected to ease pressure on overstretched facilities serving scattered communities with limited access and long-standing gaps in emergency care provision.

Residents say the new unit represents long-awaited relief for mothers who previously depended on distant hospitals and unreliable transport during emergencies across difficult terrain.

Health officials acknowledge that while infrastructure is improving, staffing challenges remain a major obstacle to effective service delivery in remote areas across the county.

They note that recruitment and retention of skilled personnel in rural postings remains difficult due to limited incentives and harsh working conditions.

Local leaders emphasise stronger referral systems linking dispensaries, health centres and county hospitals to reduce delays in emergency maternal cases.

Public health advocates stress the need for community education to encourage early antenatal visits and timely health-seeking behaviour among expectant mothers.

Despite challenges, ongoing partnerships and health campaigns are improving awareness and access to emergency obstetric services across Baringo.

However, stakeholders agree that long-term investment in staffing, transport and infrastructure is essential to sustain progress in maternal health outcomes.

Ultimately, stakeholders say reducing maternal deaths in Baringo will depend on sustained political will, adequate budget allocation and coordinated action across health and security sectors.

They stress that maternal health cannot be addressed in isolation, as it is closely tied to infrastructure, education, and community behaviour.

With continued investment and collaboration, they believe even the most remote parts of the county can begin to record safer pregnancies, fewer complications, and improved survival for both mothers and newborns over time as systems strengthen across all underserved regions of the county and beyond consistently.

County officials reaffirm commitment to improve maternal health outcomes across rural communities in Baringo county.