Empowering mothers key to reducing maternal and perinatal deaths

A sonographer David Kariha (in red coat right) assists Tessie Mudavadi, wife to the Prime Cabinet Secretary in using the point of care ultrasound on a pregnant woman after she officiated a free maternal screening camp on April 5, 2023. [Fidelis Kabunyi, Standard]

During a recent forum to offer free sensitisation to mothers on matters pregnancy, labour and childbirth, a first-time mother confessed that she didn’t know women needed to take folic acid supplements three months before getting pregnant.

This confession opened a lid on the existing information gap among mothers, their partners and those planning to become parents when it comes to antenatal and postnatal care. In this forum, dubbed Mommy and Baby Fair organised annually by the Nairobi Hospital, over 300 mothers and their nannies from different socio-economic backgrounds attended the free training sessions about pregnancy care, pain relief options in labour, childbirth, lactation, immunisation, nanny training, nutrition for mothers and myths surrounding pregnancy and delivery.

But why is focus on the mother important? The third UN Sustainable Development Goal is to ensure healthy lives and to promote well-being for all persons at all ages. Specifically, with regard to maternal health, the goal is to reduce maternal mortality ratio to less than 70 per 100,000 live births.

According to the World Health Organisation, global maternal mortality ratio in 2020 was 223 per 100,000 live births. Almost 95 per cent of these maternal deaths occur in low and lower-middle-income countries with 70 per cent occurring in sub-Saharan Africa. In Kenya, the maternal mortality ratio in 2020 was 530 per 100,000 live births. This is a 7.7 per cent improvement from 2000 when it was 564 per 100,000 live births. The United Nations Population Fund says that Kenya’s maternal mortality ratio, the number of women dying of pregnancy-related causes, stands at 355 deaths per 100,000 live births.

This means that there are nearly 5,000 women and girls dying annually due to pregnancy and childbirth complications. While access to skilled birth attendance has improved from 62 per cent to about 70 per cent over the last seven years, over 80 per cent of maternal deaths are attributed to poor quality of care.

Research has revealed that causes of preventable maternal deaths can be classified into three, namely; delay in deciding to seek healthcare, delay in reaching a healthcare facility and delay in delivery of quality health care at a facility. This means that for maternal morbidity and mortality rates to reduce in Kenya, increased access to affordable and quality maternal care, including family planning services for our mothers is critical. We also need sustainable financing to strengthen our health systems so as to empower our mothers before and after childbirth. There is a ray of hope though a lot more needs to be done.

The 2022 Kenya Demographic Health Survey Report indicates that 98 per cent of women reported receiving antenatal care from a skilled health provider, with 66 per cent attending four or more antenatal visits. This could be one of the strategies that has caused a decrease in cases of maternal mortality.

The World Health Organisation advocates that a pregnant woman should have at least four antenatal visits during her pregnancy. Antenatal visits are important to diagnose if a woman has any condition or assess her to determine whether she is at risk of anything and implement strategies to prevent it in good time.

As we implement universal health coverage, deliberate programmes and strategies targeting mothers, expectant mothers and those planning to become mothers are necessary to ensure universal access to patient-centered, skilled midwifery care to end preventable maternal and perinatal deaths. We will cover sufficient ground if these programmes target, particularly, the marginalised segments of our society in informal urban settlements and rural areas. We can do it.

Dr Mruttu is a consultant obstetrician and gynecologist at The Nairobi Hospital

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