Dying to give birth in northern Kenya

Garissa, Kenya – Mumina Sahal, 23, recalled the horrible ordeal she went through while giving birth to her second child with the help of a midwife in northeastern Kenya – a move that nearly killed her.

“I was experiencing mild labour pain and went to the hospital in Garissa, but the nurses told me to take a walk inside the compound since the beds were fully occupied,” Mumina said. “When I went back to the delivery ward again, they told me my time limit was over, and I could only deliver through cesarean section.”

However, her husband opposed the idea of her going under the knife.

He took her out of the hospital to deliver the baby at home with the help of a traditional birth attendant. Mumina said she went through such a traumatic experience with the midwife – and near death – that she wishes she could forget all about it. 

Mothers are often told to go home prematurely to avoid congestion at the hospitals [Alinoor Moulid Bosh/Al Jazeera]

“Although I was not ready to take the risk of delivering at home, I had no choice but to do so, and it nearly cost me my life and the baby’s,” she said.

Mumina is one of many women in this region to face such a predicament. Home deliveries often turn tragic with either the mother or the child dying. Such deaths are dealing a blow to maternal health initiatives in northern Kenya, where even basic healthcare is inaccessible for many.

Kenya is rated among the 10 most dangerous countries for pregnant women, according to a United Nations report, which highlights the trend of maternal deaths from 1990 to 2013. It indicated last year alone 6,300 women in Kenya died from pregnancy-related complications. Other reports estimate up to 8,000 a year die.

According to Kenya’s 2008-2009 Demographic and Health Survey, between 1,000 and 1,200 women die during delivery per 100,000 births in northeastern Kenya, compared to the national rate of 488 deaths per 100,000.

Moreover, 68 percent of women deliver without the assistance of a skilled medical professional. 

In a bid to change the trend, Kenya’s First Lady Margaret Kenyatta launched a campaign dubbed ‘Beyond Zero’ with the aim of reducing maternal deaths by deploying mobile health clinics to remote areas in the country.

“There could be no more a fitting tribute to mothers than to ensure they are provided with a safe environment and supported by skilled health-care providers while giving life,” Kenyatta said.

Many infants are born prematurely because of pregnancy complications [Alinoor Moulid Bosh/Al Jazeera]

So far, the initiative has delivered seven fully kitted mobile clinics to seven counties with the highest maternal and newborn mortality rates.

Kenya’s government also initiated a policy of free maternity services in all public facilities in June. Since then, many hospitals have reported being overwhelmed by an increase in the number of deliveries performed and overcrowding in maternity wards.

Currently, an estimated 35 percent of women in the region give birth in health centres, while 65 percent of mothers prefer to give birth at home with the assistance of a traditional midwife. 

Garissa county Secretary of Health Sofia Sheikh Omar said the free maternity services for the mothers have led to an increase in hospital attendance, putting pressure on hospitals ill-equipped and understaffed for such a load.

“You will see the deliveries have increased a lot, to the point where nurses are unable to manage and they don’t have enough space for it,” she told Al Jazeera.

Her sentiments were echoed by healthcare staff at Garissa Referral Hospital.

Midwife Fatuma Jireey assists more than 20 mothers every month to deliver at home [Alinoor labour Bosh/Al Jazeera]

As a result, mothers are forced to look for experienced traditional midwives who will help them in home delivery.

Fatuma Jireey, 78, is a traditional midwife who has helped women deliver at home for the last 40 years, boasting  she encountered only a few life-threatening experiences.

“I inherited these skills from my mother. It is an overwhelming task knowing that you are helping welcome a new soul to this Earth,” she said. “I assist more than 20 mothers every month to deliver at home.”

She said her work entails risks that she knows too well, and she often advises going to a hospital at the slightest sign of any problem. 

Garissa is among five counties in Kenya where more than half of the deaths occur during delivery, according to the United Nations Population Fund report.

Home deliveries have been blamed for the high maternal mortality rate in the region, where female genital mutilation, which is rampant here, complicates the situation.

At Korkora dispensary, the delivery room can serve only one patient [Alinoor Moulid Bosh/Al Jazeera]

More than 90 percent of women in the region require cesarean operations for at least one of their deliveries because of female circumcision, according to health officials.

Maryan Bule, a resident of Korkora village east of Garissa, narrated the ordeal her sister went through under the care of a traditional midwife. She said her sister lost a lot of blood in the delivery process, leading to her death.

“When my sister was about to deliver she started swelling. Then incessant bleeding followed. The midwife recommended that we take her to the nearby dispensary but it was too late,” said Bule.

The situation here is complicated further by a cultural mindset that forces women not to seek assistance from male medical practitioners.

A nurse at Korkora dispensary feels for the baby’s position and listens to its heartbeat [Alinoor Moulid Bosh/Al Jazeera]

“Pregnant women will resist going to the hospital where there is even a single male staff, but we are trying our best to battle this notion,” said Mohamed Aden, a community elder.

Authorities here say to overcome such cultural barriers, traditional birth attendants must be taken on board and encouraged so that they will refer their clients to health facilities to receive proper maternal healthcare.

“We have made so many steps. First of all whenever we hire staff we consider more female midwives than male midwives because of our cultural beliefs,” the Health Secretary Omar said. “We also welcome the traditional birth attendants in our health facilities, so that they can stay with the mothers and assist whenever needed.”