The Millennium Development Goals, agreed by global leaders in 2000 to reduce poverty levels dramatically, reach their conclusion at the end of 2015.
Among the eight goals set was one that addressed maternal health. The aim was to reduce the childbirth-related deaths of women by 75 percent over 1990 levels, and achieve universal access to reproductive health. By 2013, the rate worldwide had fallen 45 percent from 380 to 210 deaths per 100,000 live births. But in sub-Saharan Africa, progress was less marked, so that today it holds the highest level of such deaths worldwide, some 63 percent.
In Kenya, women are still 40 times more likely to die during childbirth than they are in the United Kingdom. Generally, the causes are complications that could easily be dealt with if they had access to professional health care. Obstructed labor, hemorrhaging and eclampsia are common but treatable — many women experience these every day in maternity wards throughout the U.K. and survive.
But a lack of even basic health care means the odds are stacked against pregnant women in Kenya. In rural areas, especially in Maasai communities, it is normal to give birth at home. Culture dictates that the men make the decision whether a woman goes to a hospital or a pharmacy or not. Location dictates that even if the man does agree, it is very costly and sometimes impossible to get to a hospital due to the remote nature of the villages and the lack of decent roads.
While MDG 5 seeks to provide assisted health care for 90 percent of births worldwide, only 44 percent of Kenyan women have access to a doctor, nurse or midwife during labor. In Narok, a county in western Kenya I visited two months ago, the figure is less than 30 percent.
In one village, Pusangi, I met Nashoro Ndayia, who had experienced the harsh reality of how restricted access to health care can very easily mean a matter of life or death. The nearest hospital is 46 kilometers away and there are no proper roads; just dirt tracks through the bush along rough tracks, which means that even if a vehicle is available, it can take up to three hours.
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After two days in labor, Nashoro’s daughter 19-year-old Semeyian had given birth to her third son. The birth went well but the placenta was not delivered afterwards. She felt sick and was bleeding heavily. After two hours, Nashoro started to look for a vehicle to take her daughter to hospital. At the time there were no ambulances in that part of Kenya, so Nashoro had to persuade her husband to pay for a vehicle. This meant selling one of their cows.
For the Maasai, cows hold enormous significance, representing status as well as wealth, and to some extent food security as the Masai drink the blood of their livestock mixed with milk. It was not a decision that a Maasai man would take lightly. Despite his reluctance, Nashoro’s husband agreed to part with one of his animals to raise the 7,000 Kenyan shillings (around $77) to pay for the car.
Just five minutes away from the hospital, however, Semeyian died in the back of the vehicle.
Such deaths are not uncommon. Many of the women I spoke to told me similar stories — complications before, during or after birth had led to the death of their daughters, sisters and friends, and often their babies. One mother of seven told me how “there are very many women who have passed on.” She said, “Many children are without their mothers now because they have died from those kinds of complications. The wife of my brother passed away because of excessive bleeding in birth. If the ambulance was there, these people would have survived. They would have got the medication and the bleeding would stop. Very many children are orphans”.
A large portion of these deaths could no doubt be prevented if the work of the Transmara Rural Development Program, of which Christian Aid is a partner, was scaled up. Thanks to this program, there are now monthly mobile health clinics that reach some of the most remote communities, offering a range of services including vaccinations and antenatal care. In addition, they have a 4x4 ambulance which acts as a lifeline to communities who struggle to rent private vehicles — a development that could have saved Semeyian, who died in 2012.
The group have their work cut out for them. Not only are they up against the social norm of having babies at home, but also the deep-rooted beliefs of the Maasai. Despite the fact that it is the women who raise the children, look after the livestock, collect the firewood, milk the cattle and feed the family, it is the men who make decisions. They are in charge, and having been brought up to believe that women should give birth at home, they believe they can rely on traditional herbs to treat whatever ailments the women may suffer.
To address these ingrained beliefs, TRDP works with both men and women in the villages, forming support groups for each, offering a space to share experiences, and helping the villagers understand the benefits of accessing professional health care. Progress takes time, but change is happening.
This year, Christian Aid’s fundraising efforts for such projects is being boosted by the British government, which has agreed to match every pound (up to 5 million pounds or $7.8 million) donated to our Christmas Appeal so more lives can be saved.
Maternal health will only improve when there is adequate investment in quality care for all women during pregnancy and childbirth and overall progress toward gender equality and women’s rights. Reducing maternal mortality is likely to feature in the next set of sustainable development goals which are currently under discussion at the United Nations, and Kenya is playing a leading role within this debate.
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