DR NG’ANG’A: Why Death Still Stalks Pregnant Kenyan Women

Every day, about 830 women die due to preventable pregnancy and childbirth complications, the World Health Organisation estimates. Sadly, 99 per cent of these deaths occur in developing nations. Every year, Kenya loses over 6,000 women due to complications of pregnancy and childbirth. Most of these deaths occur in the rural areas. This high number of deaths is unacceptable considering that pregnancy is not a disease. No woman should die while giving life.

As part of a two-part series on leading killer conditions in Kenya, this week we have a look at conditions that can be fatal to pregnant mothers and their babies.

Abortion in Kenya is illegal. The only exception to this, is termination of pregnancy for medical reasons (these are cases where the mother risks losing her life if she carries the pregnancy to term).

In Kenya, most illegal abortions are done in women aged 15-24 years. Since there is no access to safe abortion, most women turn to backstreet clinics.

In some cases, desperate women carry out abortions by inserting knitting needles or metal hangers into the womb or overdosing with over-the-counter medication and sometimes even pesticides. Most deaths from illegal abortions are due to either bleeding or infection.

Unwanted pregnancies are as a result of lack of family planning. In Kenya, approximately 60 percent of women use some form of contraception (either modern or traditional). Unfortunately, very few women under the age of 24 years use regular contraceptive. They still feel embarrassed to go to family planning clinics, especially if they are unmarried.

It is thought that about 10-15 percent of women develop depression in the weeks following childbirth. This is medically known as post-partum depression. In most cases, mothers with new borns are overwhelmed by feelings of sadness, lethargy, anxiety, hopelessness, anger, guilt and fatigue.

Although most of these feelings are targeted towards herself, some of these negative feelings may be towards her baby. In rare cases, psychosis may develop. This is a severe form of mental illness which may involve getting hallucinations and delusions in addition to the volatile mood changes.

Most women with post-partum depression go undiagnosed and are often labelled as being ‘fussy’, ‘moody’ or even ‘lazy’. In this dark abyss, thoughts of committing suicide are not unusual.

Occasionally, a woman with post-partum depression may harm her baby. Although suicide is not a common cause of maternal death, society shrouds this condition in secrecy and most women battling with post-partum depression often have no support.

Their friends and family are oblivious of the fact that it can have a tragic outcome.

High blood pressure can be fatal in pregnancy. Usually, most women are diagnosed with pregnancy associated high blood pressure in the fourth or fifth month of pregnancy. In severe cases, seizures may develop. Poorly controlled high blood pressure can also lead to growth retardation of the baby and in some cases, miscarriage.

Prolonged labour, obstructed labour (where the baby gets stuck in the womb or birth canal) or bleeding either in pregnancy or immediately after delivery can all be fatal. These are the commonest complications of childbirth. Most of them require early intervention with access to theatre and blood transfusion if need be.

The majority of women in Kenya either deliver in lower level health facilities like health centres (have no theatres or blood banks) or they opt to deliver at home under the care of a traditional birth attendant. Most women in this situation, also do not go for the necessary clinics during pregnancy and don’t get scans like ultrasound which may be able to detect possible future complications.

Bacterial infections may occur during pregnancy or immediately after childbirth. The most common bacterial infection in pregnancy involves the urinary system. This can be fatal if it is located in the kidneys and remains untreated.

Leakage of amniotic fluid before labour can also predispose a woman to infection from the birth canal. This infection can spread to the contents of her womb which can be fatal to both mother and baby.

Kenya is still dealing with complications of malaria in pregnancy. Malaria can lead to miscarriages and even death of the mother.

The loss of mothers and their babies is largely preventable if women have access to prompt treatment. They also need to be educated on what constitute danger signs in pregnancy. Those on treatment for conditions like high blood pressure need to be compliant to their therapy.

All women should go for regular clinic visits during pregnancy. (A minimum of four visits is required. The initial visit should be within the first three months of pregnancy). Ideally, all women should deliver under the supervision of a qualified health worker.

Those who opt to deliver with the help of a traditional birth attendant should be near hospitals should problems arise. The traditional birth attendants should also be trained to recognise potentially life threatening conditions during labour.