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Floods, drought blocking access to maternal health services in Tana River

Coast
 When stranded passengers coming to Mombasa from Lamu boarded speed boats following a heavy down pour on December 8, 2023. [Maarufu Mohamed, Standard]

Asha Mumina Hussein, 27, was at home with her two children when water gushed into her house and completely submerged it. The raging waters swept villages, killed livestock and displaced thousands of people.

After wading through water and debris for hours, Asha and her family were among hundreds of individuals rescued from her house in Abaganda village. She was evacuated to a camp approximately 10 kilometres from her home.

Though grateful that she and her children were safe, her mind was on her unborn child. The floods would cover the entire area for kilometres. Should her labour start, where would she go to deliver her child?

On December 20, she went into labour. Her worst fears had come true — the roads to the nearest hospital were impassable.

Narrating her ordeal, Asha says some elderly women at the camp tugged her fourth-born baby out of her body as she lacked the strength to push. Immediately after birth, she began to bleed profusely from the tear.

The women reached out to a nurse at a nearby dispensary but it was useless — there was no way for her to reach Asha. 

“I lost consciousness after birth. The women gave me herbs to stop the bleeding but they did not work. I prayed to God telling Him that even if I died, He should rescue my baby,” Asha recalls.

It took about five hours for the bleeding to stop, leaving her with blood deficiency. With no way to get a blood transfusion, her only hope was a diet of iron-rich foods – but this was impossible at the camp. 

“I survived death by a whisker. I did not have any strength left because of the bleeding,” Asha says.

Tana River County has, for decades, endured climate calamities — from failed rainy seasons to flooding. The latest was caused by El Nino rains that devastated parts of Kenya. 

While displaced families endured harsh conditions in makeshift camps, the struggle took a toll on pregnant who lost access to maternal services as hospitals were submerged in water.

A larger number delivered in unsafe spaces in the camps, risking death and health complications.

Zainab Moge, 35, also suffered perineal tears (tears between the vaginal and anal openings) while giving birth. She delivered at 3am on January 4 six hours before a nurse could reach her at the camp. 

By the time the nurse arrived, Zainab was still bleeding and too weak to be transported to a hospital. 

Before the floods, Zainab had attended all antenatal care clinics and had planned to deliver in a hospital where complications could easily be handled.

“Though I delivered two of my four children at home, I had plans to deliver in hospital because I knew it was a safe space for me and my child. It was painful bleeding at the camp, with nothing much to stop it,” recalls Moge.

She says she has healed from the wounds and that her baby is growing strong each day but she says that she is lucky to be alive and that more should be done to prevent the risk of death for mothers and babies in displacement camps. 

“It is sad that during calamities, pregnant women are vulnerable. My plea is to the government to dispatch a team of skilled birth attendants to camps whenever disasters happen,” Zainab says. 

Zainab and Asha’s experiences paint a picture of the struggle that thousands of women go through during calamities. 

Tana Delta Reproductive health coordinator Phedis Sanita says erratic weather patterns greatly affect the outcome of maternal and neonatal health.

In times of drought, women migrate with their families in search of water and pasture for their stock, and when it floods, they are also affected as they migrate to safer places, making it a challenge to access maternal health services.

“Maternal health services are the least sought during calamities,” says Sanita.

Among services that were highly affected during floods are family planning, ANC visits, deliveries and postnatal care. Routine childhood immunisation also dropped.

Last year in Tana River Delta, at least eight facilities were inaccessible due to floods.

Most deliveries were therefore conducted by unskilled birth attendants increasing the risk of stillbirths and excessive bleeding.

During the recent floods, approximately 15 mothers delivered at home, with two fresh stillbirths reported. 

Excessive bleeding, Sanita explains, was highly reported among women who have undergone Female Genital Mutilation (FGM).

Many pregnant women in the county also suffer from anaemia due to poor diet, and at birth, they also bleed excessively a condition that requires transfusion — services only offered in hospitals.

Bencliffe Agalla, the Nursing Officer in charge at Sera Dispensary says that during the floods, he received numerous calls from women due for delivery but he could not help.

“Picture a pregnant woman in labour, crying for help as she bleeds, but you can not offer help?” Agalla poses.

In one incident, Agalla braved the floods, walking in the flood waters to rescue a woman in a camp who was bleeding excessively and was unconscious.

Dr Laura Oyiengo, Health Specialist in maternal Newborn Health at UNICEF Kenya notes that the time of labour, childbirth and the 24 hours following birth are critical for the survival of the mother, unborn baby, and newborn as this is a period when the risk to lose of life is at the highest.

Further, Oyiengo notes that disruption of critical maternal health services such as antenatal care, the inability of women to deliver under skilled care can lead to pregnancy complications and loss of life for the mother and/or newborn.

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