Kenya: Train midwives to reduce maternal deaths

NAIROBI: In the last 15 years or so, the world, and in particular the developing nations, has stepped up efforts to lower maternal and childbirth mortality rates in accordance with the precepts of the Millennium Development Goals (MDGs) four and five, which focus on reducing child mortality and improving maternal health care.

Of particular note is the tremendous progress that has been made to see the maternal mortality ratio drop by 45 per cent between 1990 and 2013, from 380 to 210 deaths per 100,000 live births according to a United Nations report.

This is captured as part of the review of the progress made to achieve the target set under the MDGs that sought to reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.

The report notes that all regions have made progress, but accelerated interventions are required in order meet the target. It goes on to reveal that in eastern Asia, northern Africa and southern Asia, maternal mortality has declined by around two-thirds in the 15-year period.

Seemingly, Kenya has not been left behind in the invigorated push to end maternal deaths in line with the targets set by MDG number five. Over the last half-a-decade in particular, there has been a deliberate effort by both the public and private sectors to ensure the targets are met.

However, whereas the efforts have been substantive, Kenya ranks poorly compared to other countries on the continent, and indeed the globe, according to the 2014 Unicef Committing to Child Survival: A Promise Renewed report.

The report, which focuses on providing a global movement to end preventable child deaths by accelerating progress on maternal, newborn and child survival, ranks Kenya 10th in the world - among countries with the highest absolute number of under-five deaths recorded in 2013.

The report indicates that approximately two-thirds of all neonatal deaths worldwide occur in 10 countries. Kenya is positioned 10th in this ranking, having recorded 40,000 neonatal deaths in 2013 alone, representing one per cent of the world's neonatal deaths during the period under review.

Among African countries, Nigeria had the highest number of neonatal deaths at 262,000 in 2013 alone or nine per cent of the total number of deaths across the world, according to the report.

The country is only preceded by India in the ranking, which recorded 748,000 neonatal deaths in 2013 alone, representing 27 per cent of the world's total in this regard.

In comparison then, it can plausibly be argued that Kenya is not doing very badly in its endeavour to reduce the number of maternal deaths. However, it is evident that a lot more needs to be done to correct the current situation.

In 2013, the report indicates, almost 1 million newborns died on the day they were born - accounting for 16 per cent of all under-five deaths and more than a third of all neonatal deaths.

In Africa, this situation can easily be corrected. Midwives deliver the majority of births on the continent. More often than not, however, given Africa's social-cultural practices and the slow progress with which they have evolved to adapt to modern practices, the midwifery process is challenged. This has led to the thousands of neonatal deaths that have been witnessed.

Fortunately, this situation can be reversed. By equipping midwives across the continent with practical and modern knowledge on the best childbirth practices, Kenya, and indeed the continent, will have solved one of the many causes of the high number of neonatal deaths.

After equipping them with the requisite skills, knowledge and expertise, an elaborate programme that ensures the trained midwives are absorbed into the health sector and distributed across the country should be effected.

This will ensure that midwives are available where and when they are needed, and that they have the skills and competence to support normal deliveries by identifying high-risk births in good time to save the mothers and newborns.

One such project has been undertaken by Amref Health Africa, in partnership with the Chase Group Foundation, and aims to train 15,000 midwives across Africa. So far, the programme has reached out to 5,909 midwives. The three-year-old partnership aims to address the shortage of midwives in rural Kenya.

This is a practical example of how the private sector can partner with the healthcare industry to improve maternal health.

Basic emergency obstetric and neonatal care training has been supported in Kenya, including in arid areas in northern Kenya. Midwives receive refresher training in identifying and managing high-risk deliveries based on the knowledge that in rural areas, this could mean the difference between life and death.

The initiative, if taken up by the Government in collaboration with the private sector and development partners, would enhance the provision of healthcare for pregnant women and significantly reduce the number of maternal deaths in a bid to surpass the targets set by MDGs four and five.