Alarmed by escalating cost of delivering babies, the World Health Organisation (WHO) has moved to ensure affordable services.
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Last week, the WHO made 56 recommendations to member states which if observed could dramatically reduce the cost of giving birth.
The organisation wants elective caesarian births, instrumental vaginal births, pain blocking injections and early labour inducing medicines discouraged.
WHO wants women to go back to natural pushing and reclaim the unique experience of giving birth.
“The increasing medicalisation of childbirth has undermined the woman’s capability and the unique experience of giving birth,” says Dr Princess Nothemba Simelela of WHO.
The 26 recommendations are expected to tame what WHO calls too many and too early medical interventions.
This comes as Kenya public insurance reimbursements for Cesarean (CS) births surpass those for normal delivery.
Last year the National Hospital Insurance Fund’s (NHIF) paid Sh1.2 billion for C-section births taking 58.2 per cent of its maternity costs.
NHIF chief executive Geoffrey Mwangi says payments for CS surpassed budgets with about half of women having undergone the procedure.
Mr Mwangi says since NHIF does not pay for elective CS, the huge claims are either an outright fraud or some doctors are deliberately encouraging surgical births for personal financial gain.
In August, a study published by the research department of Kenyatta National Hospital (KNH) showed attending doctors to be influencing women to go for repeat CS deliveries without pointing out risks.
KNH charges about Sh53,000 for a normal birth and up to Sh152,000 for CS.
While caesarean births save lives, WHO says in many cases it is being performed without medical need, putting women and their babies at risk of short- and long-term health problems. Medical reports show demand for CS births is on the rise especially due to an expanding middle class, employed women who are insured and hospitals keen on maximising profits. Demand for CS in Kenya shot up dramatically since 2015 when the NHIF increased the reimbursement from Sh18,000 to Sh30,000. This could rise further as NHIF takes over the funding of the free maternity programme across the country through the Linda Mama, Boresha Jamii programme currently supported by Sh19 billion World Bank loan.
Insurance companies have also complained over high rates of maternity fees which have more than doubled in the last decade mainly pushed up by what WHO is calling over medicalisation of a purely normal biological process.
Charges for normal and CS deliveries rose by 90 per cent in major hospitals in the last six years to range between Sh100,000 for normal deliveries and 270,000 for C-section.
But even in the absence of CS births, WHO says doctors are too quick to take to the knife, medications and other unnecessary interventions. “The liberal use of episiotomy, for example may be linked to over-medicalisation based on ensuring financial profits for practitioners,” says the WHO document.
Episiotomy is a surgical cut made to enlarge the birth canal.
The new recommendations take note of contradictions existing in poor countries like Kenya where on one hand poor women have too little care while the rich have too much most of it unneccessary. WHO says delivering women must be accorded respect.