28 July 2014

Kenya: The Cost of Maternal Death in Kenya

Nairobi — The Millennium Development Goals (MDG) deadline of 2015 is approaching but there are concerns that Kenya will fail to achieve some of them.

This includes the goal of reducing the maternal mortality rate from the current 360 deaths per 100,000 live births to the targeted 147 per 100,000 live births.

"Although facility deliveries have increased significantly since the introduction of free maternal healthcare, our country may still not achieve the MDG target of universal access to reproductive health by the end of next year," said James Macharia, Kenya's Cabinet Secretary of Health.

MDGs 4 and 5 on reducing child mortality and improving the health of the mother respectively are particularly important, given their impact on the country's health system as a whole, he said, noting that more than 50 percent of the problems facing the country's health sector involve maternal and child health.

Macharia's comments referred to the findings in A Price to High to Bear, a report released in March. Produced jointly by Family Care International, the International Center for Research on Women and the Kenya Medical Research Institute/Centers for Disease Control and Prevention Research and Public Health Collaboration (KEMRI/CDC), the report explores the economic, social and emotional impact on families of a woman's death during pregnancy or childbirth.

The survey was conducted between 2011 and 2013 in the Rarieda, Gem and Siaya sub-counties in western Kenya. The region has some of the highest HIV, tuberculosis and malaria incidences and exhibits some of the worst health indicators in the country.

The maternal mortality ratio in the region was estimated to be 740 deaths per 100,000 live births in the period 2003-2008. This is more than twice the 2010 national maternal mortality ratio estimated by the World Health Organization to be 360 deaths per 100,000 births for Kenya as a whole.

Maternal mortality is defined as the death of a woman while pregnant, during delivery or within 42 days of delivery or the termination of a pregnancy.

The report showed that maternal deaths also had significant impact on newborn deaths. Of the 59 maternal deaths recorded in the study, only 15 of the babies survived the first 60 days of life.

The survey also tracked the economic impact. It found that families that experienced a maternal death spent approximately a third of their total annual consumption expenditure to obtain care for serious complications during pregnancy and childbirth. The cost was between three and six times more than that spent by households in which a woman gave birth safely.

"This approaches what the World Health Organization calls a 'catastrophic' cost (40 percent of disposable income) and suggests that some families may avoid or delay emergency care because of difficulty in covering the costs of transport and services," according to the report.

The women who died had contributed an average of 61 hours of household work each week and 88 percent of the affected families reported that the loss of this contribution reduced other family members' ability to provide earnings for the household.

This often resulted in surviving children being withdrawn from school because the family could no longer afford school fees. The performance of children who remained in school often suffered due to increased household duties in addition to grief over the loss of their mother, according to the report.

"This data presents a compelling rationale to policy makers for more investment and resources in maternal and newborn services," said Dr. Frank Odhiambo, one of the report's researchers and the branch chief of the Health and Demographic Surveillance System (HDSS) at KEMRI/CDC.

Editing by Lisa Anderson: lisa.b.anderson@thomsonreuters.com

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