Early marriages exposing ASAL girls to maternal deaths

Early marriages puts more girls in arid and semi-arid lands (ASALs) at a greater risk of maternal deaths and childbirth complications, Mandera County Health CEC Dr Adan Mohamed has said.

“Traditional beliefs and values including early marriages influence poor health seeking behavious among these(ASALs) communities,” he said during a November 5, virtual meeting on End Term Evaluation on the UN H6 Joint Programme on Reproductive, Maternal, New-born, Child and Adolescent Health (RMNCAH) 2015-2020.

“Girls are married off at 12 years when they are anatomically immature and that has a domino effect,” stated Dr Mohamed during the meeting organised by UN H6(Global Health Partnership)partners-UNAids, UNFPA, Unicef, WHO, UN Women and World Bank, joint implementers of the $21 million programme, in collaboration with the Government of Kenya.

He further explained: “By the time that child becomes pregnant, it becomes an issue of teenage pregnancy. Then she has a complication like obstructed labour, the decision to give consent for caesarean  section becomes another problem.” 
The programme was implemented in Mandera, Wajir, Isiolo, Marsabit, Lamu and Migori counties. 

Maternal mortality

A 2014 study by University of Nairobi’s Population Studies and Research Institute established that 50 per cent of the total maternal deaths recorded in Kenya occur in these counties. The country’s maternal mortality rates currently stands at 362 maternal deaths per 100,000 live births.

The programme, rolled out in July 2015 and running up to December 2020, integrated provision of quality RMNCAH as well as HIV and gender-based violence (GBV) services as an innovative way of encouraging health seeking behaviours among women and girls. 

And as a result, contribute to the reduction of maternal and new-born mortality in Kenya. 
UN H6 partners’ analysis of the programme’s impact, indicates a 32 per cent increase in the number of women utilising antenatal care services.

Access to skilled attendance at birth also increased by 30 per cent as a result of sustained community-based advocacy, improved infrastructure and the provision of health equipment. 
Further, more women sought HIV testing and counselling at antenatal clinics, with Lamu County recording the highest increase of 59 per cent. 

In 2015, the rates were at 40 per cent compared to 99 per cent in 2020.
Additionally, a high number of GBV survivors sought health services with Migori County leading with a 50 per cent in upsurge.

High insecurity

Insecurity, however, remains a challenge to the delivery of quality maternal and other health services in  Mandera, Wajir and Lamu counties, as skilled healthcare workers flee, leading to understaffed health facilities.
While in Isiolo and Marsabit counties, socio-cultural barriers have led to the low utilisation of key interventions such as maternity shelters.

Dr Mohamed, exemplified Kutulo Sub-county in Mandera County where cultural beliefs have influenced negative maternal health seeking behaviours among local women.

He said a probe into factors causing majority of the women in the sub-county to deliver at home instead of going to nearby health facility, established that women were uncomfortable with being attended to by male nurses in the maternity wards.

Health ministry's Head of Family Health department Dr Issak Bashir said gender roles and power dynamics at the family level negatively affect women’s access to health services.

 “Without taking into account a population’s SRH (Sexual and Reproductive Health) needs; UHC (Universal Health Coverage) is impossible to achieve as most basic people’s health needs are linked to SRH including family planning, maternal, new-born, and child health and GBV services,” he said.

Health ministry CAS Dr Mercy Mwangangi said the ministry continues to prioritise progressive implementation of SHR interventions across the country.

This, she said, is to “ensure access to an essential package of SRH interventions as an integral component of the UHC Essential Benefit Package.”

UNFPA, RMNCAH Senior Program Coordinator Ms Rael Mutai said UHC is crucial to increasing access to RMNCAH services.
“Integrating the comprehensive package of RMNCAH services in the proposed UHC essential benefit package will go along way in increasing access(to RMNCAH services),” she said.

Sammy Muraya, Project Manager at Journalists for Human Rights said, "It's really sad to note that some of the areas that were marginalised post-independence are still facing health challenges in this millennium. We should not be losing young girls to problems that are solvable. Being pregnant should not be a death sentence."