Why city slum mothers still give birth at home

Ms Eunice Okot with her ten-month-old daughter Sandra Auma during an interview in their house at Korogocho slums, in Nairobi, on February 18, 2011 . PHOTO/STEPHEN MUDIARI

Difficulties facing motherhood in the slums are not new to Kenya, with only 33 per cent of Government health facilities supporting quality sterilisation of delivery equipment.

The deplorable conditions facing mothers during pregnancy and childbirth are still at an all time high, with White Ribbon Alliance Kenya (WRA) noting that empowering women is the only way out to ensure that they take charge of their own health.

One such case that might have been added to the maternal death statistics is Eunice Okot’s, who lives in a shack in Korogocho slums.

Hers is a situation that keeps repeating itself in the slums and rural areas in the country, the difference here being that she was able to give birth safely.

“I started experiencing pain, which passed for labour at about 9am. I then decided to go to Tumaini healthcare that is about two kilometres from my house for further check up.

“However, the doctors told me that what I was experiencing was not labour but that I should pay Sh500 for treatment,” says the shy mother of two.

Since her husband was not around and she had no money, she went back to the house and slept instead, making what seemed to be a beautiful sunny day in April turn one of the longest, recalls the 22-year-old.

She was, however, upbeat following the information the doctor had shared with her to the effect that she was not in labour, little knowing she was wrongly diagnosed.

Day turned into night and then into nightmare. At 2am, Eunice was writhing in pain, with her husband not knowing what to do.

But with the few handy skills she could remember, she took care of herself, while her neighbours walked the distance to get a midwife.

The drama of childbirth kept the neighbourhood up till the wee hours of the morning in the shanties that can barely accommodate a woman in labour, with little space to stretch legs.

“I delivered an hour later, and the midwife was only there to help me cut the umbilical cord. I was lucky to have managed it all through the pain.

“Most women cannot do it on their own with many of them developing complications mainly due to lack of oxygen. The baby’s position can also bring complications,” said Eunice.

She gave birth to a baby girl without a left hand and efforts to get help from the hospitals nearby proved futile with most of them referring her to Kenyatta Hospital.

According to WRA birth atlas, less than 6 per cent of health workers in Kenya know the signs of postpartum haemorrhage when questioned, with only 25 per cent of hospitals having all the medicines needed to manage serious complications.

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality. All women who carry a pregnancy beyond 20 weeks’ gestation are at risk.

Although maternal mortality rates have declined greatly in the developed world, PPH remains a leading cause of maternal mortality elsewhere.

More than half of the women giving birth in Kenya do it without the skilled care that could save their lives. Many more give birth at home, exposing them to high risk of death. In some regions, 10 per cent of women do not give birth in hospitals.

Ruth Anyango, 23, also from Korogocho, was attended to by a midwife when labour pangs came calling. She recalls: “It was a Sunday morning as I was preparing to go to church. I felt a sudden pain and could not even move.”

“My husband with help from some neighbours took me to a midwife — who has since moved to a different slum — to help me out.

“I was in pain and the lady also discovered that the baby was not positioned well; I would have faced major complications, if I hadn’t sought the help of a skilled professional,” Ruth adds.

Many women in the rural and slum areas are forced to either deliver at home or seek the help of birth attendants.

Most end up dying in the process due to complications; they complain that the distance from where they reside to the hospital is far and the cost high.

But the Director of Public Health and Sanitation, Dr Shahnaz Sharif, says the government already has programs in the slums that ensure that pregnant women reach clinics.

“We have projects in pilot areas like Korogocho and Kibera, where we give vouchers to expectant women and they are accredited for healthcare once they are due to deliver.

“I also think they should not complain since we are working on giving maximum healthcare in the country,” Dr Sharif said.

He cited North Eastern Province as having hospitals far away, but still the women are able to reach their destination. “Why not in the Nairobi slums?”

The programme by the ministry has been running for three years, with the Government injecting Sh30 million annually towards the course.

Despite the programme, many mothers are still at risk because the government has not reached all affected areas.

WRA chairperson Nancy Kidula says, if every Kenyan played their part, maternal mortality would be reduced because the solutions are simple and known.

“It may look impossible, but it can be done,” Dr Kidula says. While there has been some progress towards the Millennium Development Goals, maternal health has seen least progress.

Kenya allocates only 6.4 per cent of its Budget to health, way below the 15 per cent allocation committed to in the Abuja Declaration of 2001.