Beyond blame: Why Kenya keeps losing mothers in childbirth

Medic at Rabai sub-county hospital in Kilifi county attending a pregnant woman during her clinical visit to the facility. [Marion Kithi, Standard] I still remember that night vividly. Four women arrived in labour-bleeding, terrified, and all in need of urgent care. We had one theatre. One anaesthetist. Virtually no blood. I rushed the first mother in-she lived. The second, referred after hours of delay, died as we scrambled for blood. The third made it to surgery, but needed an Intensive Care Unit (ICU) bed that we didn't have. The fourth kept crying as we moved between emergencies. There was no ICU bed for her. She lay in the ward, machines beeping weakly as we scrambled to find space. By dawn, two newborns had lost their mothers. A maternal death is a devastating life event that runs through generations. What stays with you is not just the cries, but the questions: Could I have done more? Could I have bent time to make space in the theatre? These questions linger long after the night is over. But while we mourn quietly, the world rushes to blame. Families look at us, the health professionals, with suspicion. Headlines scream "Negligence." Social media turns doctors into villains. Inside the hospital, we face audits-Maternal and Perinatal Death Surveillance and Response (MPDSR)-meant to help us learn, but too often they feel like tribunals. We recount every minute of the case, relive every decision, and still carry the quiet question: What else could I have done? Worse still, at times the focus on individual blame overshadows the systemic delays that truly cost lives, while the larger failures-the ones that truly cost lives-go unaddressed. The persisting mistrust between the community and doctors whenever a mother dies is deeply unsettling. This sometimes leads, after MPDSR, to tense moments of either clinical or medico-legal postmortems to determine the cause of death. These sessions, though emotionally heavy, often bring a sense of relief-not only for the healthcare provider but also for the grieving family. Many times, they vindicate the provider, highlighting that the real failure lies within a broken health system, not an individual's hands. Even within the hospitals, some audits are conducted as if we are on trial. We open the files, recount the moments, and the silence in the room is thick with judgment. It's true that there are times when health professionals could do better, handle things differently to save lives - and trust me, we are often the first ones to admit that and to challenge ourselves to change. But what is less often told is the story of the systems that failed long before those women reached our hands. No woman should give life and lose hers in the process, and no family should be left grieving a preventable tragedy. The data speaks volumes. Kenya still loses far too many mothers. According to the Ministry of Health, approximately 355 women die per 100,000 live births-translating to over 5,000 maternal deaths each year. Nearly a third are due to postpartum hemorrhage (PPH). Our blood banks run on empty: The Kenya National Blood Transfusion Service collects less than half the 500,000 units needed annually. We have fewer than 600 ICU beds for a population of more than 55 million. These numbers are not abstract-they are the missing lifelines on nights like the one I described. And yet, in the midst of loss, there are sparks of hope. I've seen colleagues improvise with makeshift balloons, catheters, or even use condoms to stop bleeding. I've seen boda boda riders mobilised to donate blood at midnight. I've seen teams cry together, then return to the ward, resolved that the next mother must live. These moments remind us why we stay in this fight. Then comes the hardest duty - breaking bad news. Nothing prepares you to tell a husband that the woman who just gave him a child is gone. The silence that follows your words is heavier than any judgment. Later, you walk past headlines or social media posts that judge you without context. To survive such weight can leave you drained. Many colleagues burn out. Some leave the profession. Others carry invisible scars forever. Health workers are the frontline defenders to ensure no mother dies from a preventable cause, such as excessive bleeding after birth. We have made a binding commitment to save the lives of mothers and children. We are committed to providing an immediate response and escalating the situation to include referrals if it fails to improve, all while working as a team. But we cannot win it alone. If Kenya is serious about ending maternal deaths, we must support health workers - not condemn them. Maternal death audits must be blameless, focused on learning. We need blood in our banks, ICU beds in our hospitals, functional referral networks, and counseling for the frontline staff scarred by loss. Let us keep raising the alarm, demanding answers, and championing prevention, awareness, and timely care-stopping the bleeding before it starts. We must also recognise that a child's future begins with a healthy mother. A mother who survives childbirth in good health offers her child a better chance at thriving-physically, emotionally, and cognitively. Maternal health is not just about survival. It's about development, education, and dignity. Communities must be empowered to recognise danger signs, demand quality care, and support women before, during, and after childbirth. Protecting mothers is a moral duty, a human right, and an individual promise to protect every family and every generation. Every life saved is a promise kept. If Kenya is serious about ending preventable maternal deaths, we must move beyond blame. We must make Maternal and Perinatal Death Surveillance and Response reviews blameless and learning-centered. We must invest in blood banks, build ICU capacity, strengthen referral systems, encourage community participation through increased public health awareness, and offer psychological support to health workers who carry these scars silently. Because in the end, when a mother dies in our hands, a part of us dies too. And the only way to honor her is to make sure the next one lives.

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