By Tabitha Nderitu, Womens Feature Service
Despite a waiver in maternity fees in public health institutions in Kenya, expectant women prefer not to opt for free institutional deliveries. The women cite abuse and callousness at the hands of health centre staff as the causes.
“I would rather give birth alone in the safety of my home than go to a public hospital,” says Elizabeth Wangui, 28. Wangui’s disenchantment with the public healthcare system began when she went to a government hospital to give birth to Wachira, her seventh child and, coincidentally, the only one to be born at a hospital. All her other children were delivered safely at home.
She explains, “I am a trained birth attendant. When each of my other children was born I knew exactly what to do. I only took them to the hospital for immunisation later on.”
However, she did eventually have to go hospital for the birth of her last child. “When my labour pains intensified, my husband rushed me to the hospital. By the time we got to the local institution, the pain was unbearable. There were not many doctors on duty at that time. And the nurses seemed to take their responsibilities lightly. I called out to them several times but they did not respond. When one eventually showed up, she disdainfully said that I was merely experiencing normal labour.”
The nurses instructed Wangui to climb, unassisted, onto a bare bed that was visibly too high for a pregnant woman. Eventually, Wangui gave birth with no medical personnel at her side. Shocked by the insensitive attitude of the nurses, Wangui refused to let them cut the umbilical cord or even hold her newborn.
Sadly, Wangui’s case throws light on the plight of women who suffer at the hands of public hospital staff, explaining why many women prefer to engage a traditional birth attendant (TBA) over a free institutional delivery.
A report compiled by US-based Centre for Reproductive Rights and the Federation of Women Lawyers (FIDA), Kenya Chapter, titled, ‘Obstacles to safe motherhood’ (November 2007) faults Kenyan hospitals for failing to protect women giving birth in public hospitals from abuse.
According to the report, “The verbal and physical abuse around delivery, inappropriate stitching practices and detention in health facilities documented in this report all constitute serious violations of the right to be free from torture and cruel, inhuman or degrading treatment.”
The Health Ministry, the report recommends, should implement and enforce maternal care standards that protect women’s rights and health. “The Ministry should also meet the recommended ratios for staffing in medical facilities, ensure that supplies and equipment necessary to maintain hygienic conditions are strictly enforced,” elaborates the report.
It was hoped that the government’s decision to waive fees of maternity cases in public health centres would benefit 1.2 million women annually, increase institutional deliveries, and bring down maternal and child mortality rates. However, the initiative appears to be in vain: six out of 10 expectant women still choose to deliver at home under the care of relatives and TBAs.
“Delivery under the care of a trained health worker is one of the key interventions for reducing maternal and newborn deaths. Unfortunately, many of our pregnant women are unable to deliver at health facilities due to many factors such as distance, affordability, socio-culture factors, lack of decision-making power and quality care,” said an official at the Health Ministry.
According to medical experts, the maternal mortality rate in Kenya is estimated to be between 414 and 590 deaths per 100,000 live births per year.
Kenyan Health Minister Charity Ngilu painted a dire picture with official statistics when she said, “One in every 30 newborn children die within the first 28 days of their lives from complications linked to pregnancy and childbirth.”
The Minister added: “The loss of a mother easily translates into increased risk of death of her child.”
Accused of negligence, government medical personnel – in their defence – draw attention to the shortage of hands at the 380 public hospitals in the country. There are said to be 5,000 doctors for Kenya’s fast growing population of around 32 million. This translates to about one doctor per 6,000 Kenyans, a ratio far below the World Health Organization recommendations of one doctor per 1,000 people. While 4,000 additional health workers have been recruited by the Health Ministry over the past two years, the country’s assistant Health Minister, Dr Wilfred Machage acknowledges that the system is still short of around 10,000 medical personnel.
With 60 per cent of Kenya’s population – largely women – living on less than a dollar a day, and unable to speak up for their rights, it is unlikely that the scenario in public health centres will change for the better soon.