Improve maternal healthcare for women with disabilities

Kakamega Governor Fernandes Barasa cuddles a young child at Lumakanda maternity ward wing at Lugari Sub-county on October 16, 2023. [Benjamin Sakwa, Standard]

High maternal mortality rate remains a disaster in Africa, according to World Health Organisation's Africa Regional Office. The latest report by WHO-Afro indicates that while global maternal mortality rate reduced by 34.2 per cent from 2000 to 2020, 69 per cent of maternal deaths still occur in the continent.

Kenya is one of the eight African countries with very high maternal mortality of 530 deaths in every 100,000 live births. This is way too far from the global commitment of 70 maternal deaths per 100, 000 live births by 2030. Between 2017 and 2020 alone, Kenya witnessed a 55 per cent increase in maternal mortality. Regrettably, these alarming statistics are dead silent on women with disabilities.

Health Cabinet Secretary Susan Nakhumicha in recent submissions to the Senate acknowledged that women with disabilities in the country still experience challenges accessing maternal health services due to lack of user-friendly facilities.

While noting that the ministry had evaluated whether health facilities had disability-friendly infrastructures such as ramps/lifts, washrooms, maternity beds and wheelchairs, the CS said the ministry will work together with county governments to fill the gaps that exist.

The CS added however noted that infrastructure development is capital intensive and such change would happen over a long period because there has to be a serious budgetary allocation to be able to fill the gap.

We cannot wait. In 2022, a woman with disability died during childbirth. She was not the first one. She will not be the last. Another one could not be accepted in some hospitals while in labour by due to the fact that she has cerebral palsy.

We know that women with disabilities still opt not to attend ante-natal clinics because of prevailing stigma and attitudes on the whole question of "whether women with disabilities can make good parents or not". Or even whether they are sexual beings that can carry pregnancy.

Indeed, we have many examples that tell us that big budgets and physical solutions are not only what women with disabilities need because accessing maternal healthcare has to happen now.

Many surveys tend to conceptualise access to maternal health to mean the more physical aspects such as the presence of ramps, wheelchairs and washrooms. When they speak about hospital equipment, maternity beds may be the only aspect mentioned. It is problematic if we only equate access to quality maternal health to physical solutions with assumptions that only big budgets can solve these challenges.

What is a holistic picture then? We need to think, for example, before going to the hospital, what a pregnant disabled woman will access in terms of maternal care information, the infrastructure including transport and communication, medical emergency response services, clinical counselling services among other crucial services that make up the building blocks of a strong health system.

Do community health workers package their messaging in accessible inclusive ways? Which health services do disabled women receive at rural community level, if at all? Right from the family and community level, what levels of support are disabled women receiving in terms of maternal health.

Coming to a health facility remains one important aspect of accessing quality maternal healthcare, but not the only one. A maternity bed might just be at the tail end of the pregnancy and childbirth journey!

Disability mainstreaming within healthcare provision has to be considered throughout all stages of healthcare. Otherwise, to look at it as an add-on to accessing healthcare means that not only shall we see it as an expensive venture, but it will also mean that women and girls with disabilities will continue being left behind in accessing care within health facilities.

As we indicated earlier, the repercussions are a matter of life and death. The global report on health equity for persons with disability indicates that health inequities experienced by persons with disabilities are mostly caused by unfair factors that can be avoided. It further indicates that disability inclusion is an essential investment to achieve health for all.

There is already good learning to pick from some counties as elaborated by the CS. Some of these steps to ensure access to maternal health services by women with disabilities include the availability of sign language interpreters as well as training staff in sign language to facilitate communication with deaf people. Other initiatives involve services being taken to patients with disabilities.

The good thing is that these are already happening, and they need to be scaled up. They are among the steps that will ensure that we do not wait for big budgets to afford disabled women their rights to access maternal care.

With only seven years to 2030, investments on maternal health of women with disabilities can no longer be categorised as long-term capital investments but rather as essential investments for universal health coverage that guarantee health for all.

We cannot wait!

Ms Omino is a Global Atlantic Fellow for Health Equity. Ms Ombati is a disability rights advocate