Every minute, a woman dies from pregnancy and childbirth complications somewhere in the world.
92% of pregnant women attend at least one antenatal visit
43% deliver in a health facility
44% of births are attended by a skilled attendant
Maternal Mortality Rate: 448/100 000
About 99% of maternal mortality deaths occur in developing countries. Kenya’s maternal mortality rate, like many countries in sub-Saharan Africa, is extremely high. It is estimated that there are 400 maternal deaths per 100,000 live births in the East African country1. In comparison, there are 11 maternal deaths per 100,000 in Canada. The main causes of maternal deaths include: haemorrhage, sepsis, hypertensive disorders, unsafe abortions, and obstructed labour2. A Kenyan woman has a 1 in 39 lifetime risk of maternal death and an even higher risk of suffering from disease or disability after pregnancy. As a consequence of obstructed labour, obstetric fistula are very common in this region and lead to devastating consequences for women, not only physically but emotionally as a result of the fistula and being ostracized by their families and society.
The root causes of Kenya’s high maternal mortality lie in access to health care and quality of care. Access to care is affected by: the widespread poverty in which many Kenyan women live, a culture of gender inequality that requires a husband’s permission to leave home, and the long distances that need to be traveled in order to see a health care worker. Less than 50% of Kenyan births take place in a health facility (public health facility, mission health facility or a private facility). Instead, the majority of births take place at home or a non-hospital setting in the absence of a skilled health professional (midwife, nurse trained as midwife, or doctor).
Through mobile health (M-health) activities, community health workers (CHWs) are being equipped to use clinical decision-support on Android phones to correctly triage women and newborns for care.
Should a woman be able to access care, referral linkages are weak and the clinics are often poorly resourced. The majority of Kenyan health facilities are not equipped for managing obstetric complications, and most public health facilities do not have a vehicle or driver available for emergencies. 20-40% of these facilities do not have a dependable source of electricity or water. The restricted availability of medicines, supplies, and equipment compromise the ability to deliver adequate care. Staff shortages are common, due to both a freeze in employment as well as frequent employee transfers.
Furthermore, the Kenyan medical education system is limited in its ability to prepare its doctors to deliver care in their unique and often isolated practice environment. Inconsistent educational experiences, under-resourced teaching centers, and compartmentalization of care into specialties with little integration have hindered development of provider competence and skills. The lack of supportive supervision and continuing medical education further exacerbates the problem. These factors have led to low public confidence in public health facilities, long delays in the referral of pregnancy-related complications, and the observed high rates of maternal mortality and morbidity.
Governmental and non-governmental organizations have used several strategies to address maternal health issues. These include: supporting education for girls and financial independence for women; educating communities on safe motherhood practices; improving HIV/AIDS prevention, treatment, and care; capacity building of health centers; improved service delivery of essential supplies and equipment; strengthening infrastructure such as power and water supply; and providing better training and supervision of health workers.
The objectives of the maternal, newborn and child health component of AMPATH are to:
- improve the quality of reproductive health in western Kenya through the improvement of community and facility-based care for women and their children;
- Intensify research collaborations; and
- Support further development of the infrastructure for care, education and research.
After success with the Fellowship in Gynecologic Oncology, part of a Master’s Program in Gynecologic Oncology at Moi University School of Medicine, AMPATH is currently developing a similar post-graduate program in Maternal and Fetal Health at Moi University. The goal of the program will be to train the next generation of local leaders in Women’s Health so as to promote sustainability and see change in maternal mortality in the future.
1 The World Bank. (2014). Maternal mortality ratio.
2 UNICEF. (2015). Maternal mortality.