Maternal mortality gains in limbo as mothers opt for traditional birth attendants fearing to contract virus in hospitals
Buke Jarso, 30 cuddles her one month-old baby in her manyatta at Duba village, Marsabit County. The mother of eight is lucky to have delivered under skilled care at the Marsabit County Referral Hospital.
Her last pregnancy was delicate and complicated. She delivered at home and lost the baby after two months.
"Doctors said I was anaemic and therefore, I did not want to take any chances when I got pregnant again. With the help of my husband, I registered for antenatal care and regularly visited the hospital for check-ups," she explains.
But as Ms Jarso celebrates her bundle of joy, Sulekha Hussein was not so lucky. She bled to death while giving birth.
"Ms Hussein had sought the services of a traditional birth attendant to help her deliver at home," says Mary Marangu, nurse in-charge of the Maternal Newborn Health Unit at the Marsabit County Referral Hospital.
"By the time she was rushed to the Marsabit County Referral Hospital, it was too late. She had lost too much blood and died, leaving behind five small children."
Ms Marangu alludes that the number of women coming to the facility with complications is high.
"Over the last three months, we have recorded more than 21 still births which is quite worrying."
TRADITIONAL BIRTH ATTENDANTS
The nurse indicates that scores of mothers have opted to give birth at home using traditional birth attendants. These are untrained, mostly older women, without the knowledge or materials needed to safely deliver babies, particularly when complications arise.
Majority of the expectant mothers, Ms Marangu says, are sceptical of going to the hospital. They fear they may contract the dreaded coronavirus.
According to Ms Marangu, since the first case of Covid-19 was confirmed in the country, the number of pregnant women seeking services at the referral facility has significantly dropped.
"The number of deliveries at our facility has reduced. A time like this last year, we had registered about 140 deliveries but this figure has reduced to around 100 mothers."
She says the curfew restrictions imposed by the government to manage the spread of Covid-19 has only served to exacerbate the situation.
"The few taxis that operate during curfew hours' charge exorbitantly which is way above what most mothers can afford."
Similar sentiments are echoed by the hospital's chief executive officer Liban Waqo. He says the facility continues to register a decline in the number of deliveries due to the Covid-19 pandemic.
"Under the new protocols to combat the spread of the virus, mothers coming to health facilities must wash hands, get their temperatures checked and so many other procedures, which they feel takes a lot of their time more than the normal process and therefore majority are opting to stay away," he explains during an interview at the hospital.
He laments that some of the mothers have not adhered to the guidelines.
"They come to the hospital without wearing masks, a situation that endangers the lives of health workers too."
"The greatest fear here is that if one of our staff turns positive, then I am very sure it will scare away more people."
Further, the county is vast and accessing health facilities is not easy.
"For specialised care, pregnant women have to struggle to reach Marsabit County Referral Hospital, which is more than 550km away from the farthest part of the county," adds Bokayo Arero who is the county's director of Family Health.
A similar script plays out in the neighbouring health facilities. At Hula Hula dispensary, the number of mothers coming for deliveries has also reduced.
Dahabo Abdikadir, a registered community health nurse at the facility, says the number of deliveries has dropped. The facility serves both Hula Hula and Kabinye areas with about 800 women within their reproductive age.
"We used to have 16 deliveries per month but we are registering less than five. Most health facilities in the area are grappling with stigma. Mothers are driven by fear that because hospitals are treating Covid-19 patients, chances of contracting the virus here are high."
And as the Covid-19 pandemic rages on, fears abound that gains already made in managing maternal mortality rates in the county remain in a limbo.
Before Covid-19, Marsabit County had made considerable strides in combating maternal deaths thanks to a joint initiative by the United Nations Population Fund (UNFPA) Unicef, UNaids, World Health Organisation, UN Women and World Bank.
Statistics indicate that Marsabit had registered remarkable progress by increasing the uptake of skilled birth attendance from 42 per cent to 72 per cent.
This had led to reduction in maternal deaths from 1,127 per 100,000 in 2009 to an estimated Maternal Mortality Ratio of 143 per 100,000 live births during the 2018/2019 financial year against the national average of 488 per 100,000.
The project, which ends in December, has contributed significantly in increasing hospital deliveries, antenatal check-ups, child immunisation and use of family planning methods.
Six counties benefitted during the roll out phase. The counties which included Mandera, Marsabit , Wajir, Isiolo, Lamu and Migori accounted for 50 per cent of the country's maternal mortality burden in 2009.
The joint UN project started in 2015 as a strategy to address Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH).
According to the UNFPA Country Representative Dr Ademola Olajide, Isiolo and Marsabit counties have registered significant progress under the joint RMNCAH project.
"What I have seen in Isiolo and Marsabit counties is commendable."
He, however, notes that there has been reduction in utilisation of services due to the disruption occasioned by Covid-19.
"We are glad to note that health systems have started to readjust and strengthen provision of services in spite of Covid-19," he said after a consultative meetings with senior officials in the two counties.
"UNFPA is evaluating the project to see the real impact of Covid-19 on services. Our support can no longer be business as usual but will be adjusted in such a way it not only responds to the needs of the population but realities of Covid-19," he said.
"One maternal death is a death too many."
The UNFPA representative said more emphasis should go towards ensuring retention of confidence at the community level to maintain the uptake of services, and ensure quality remains at the highest possible level in spite of the current global pandemic.
In Tana River County too, expectant women have abandoned hospital delivery services for fear of being exposed to Covid-19.
They have reverted to home delivery with the help of traditional midwives and relatives.
County Health Director Oscar Endekwa says the expectant women started avoiding the facilities after the county recorded the first case of Covid-19.
"From that very day, many of them requested to be discharged since they had heard that our first case had passed away while on treatment," he said.
Mr Endekwa said most of the patients panicked, even more, when they learnt that some medical staff had been called to take the test.
He noted that some patients in other wards other than maternity, also abandoned their beds to recover from home.
The number of patients seeking medical services has since reduced, with the respective wards recording a number of empty beds.
"Some of them are reporting back with difficulties since they cannot afford the services in private hospitals. We are counselling them as we attend to them," said Dr Endekwa.
The director has now called on traditional midwives to seek proper equipment for the home-based services and ensure they are trained on basic intervention skills in case of any difficulties during delivery.