Kenya has among the highest rates of maternal and newborn mortality in the world, and the poorest women and children are the most affected.
In 2015, Mandera County, a district of northern Kenya, was identified as the “most dangerous place to give birth” in the world by the United Nations Population Fund (UNFPA) — with a staggering 3,800 women dying during delivery in every 100,000 births, due to a lack of access to expert care.
There has been some improvement since then — in 2018 the maternal mortality rate on average for the country as a whole was 362 deaths per 100,000 live births — but it remains an incredibly risky place for expectant mothers. In the UK, by comparison, there were seven deaths per 100,000 births in 2017.
According to the Maternal and Newborn Improvement Project (MANI), which is supported by UK aid and was launched in 2015, one of the biggest issues is lack of access to urgent health care if complications arise.
More than half of women give birth at home without a skilled health care worker or birth companion present, the project says. Meanwhile, only a third of health facilities provide basic maternity services and only one in 10 hospitals provide emergency obstetric care.
Not only that, but hospitals can also be struck by power blackouts and many are not backed up by generators — meaning that vital equipment can fail when it is needed most.
The project has been implemented by a consortium led by Options since 2015, a non-profit international development consultancy working in partnership with organisations including CARE, MSI, Mannion Daniels, IHPMR, AMREF Health Africa, the Population Council, and KPMG.
Getting women to hospital
The MANI Project takes a multipronged approach to tackling these issues. Their practitioners work with the local and national Kenyan government to improve different levels of local health systems – from budgeting to training.
Through training birth companions, for example, the project was able to more than double the percentage of women giving birth with skilled attendants present in Western Kenya’s Bungoma County — from 41% to 84% — by the end of its 4-year programme.
It also offered transport vouchers to poorer women who couldn’t afford to make a trip to the hospital to give birth — with 43,000 vouchers being awarded during the project.
UK aid has also enabled the MANI Project to install solar panels to 33 health care facilities, using renewable energy to make sure that they have a reliable electricity source to turn to during blackouts.
Speaking in a video interview, Emily Wamalwa, a district nurse in Bungoma County, described a distressing incident in 2015 — before the solar panels were installed — when the power failed and staff were not able to resuscitate a newborn with breathing problems.
“We no longer lose babies because the incubators are on 24/7,” Wamalwa says of the new solar electricity. “We can keep our fridges running to store vaccines, we no longer have the problem of our vaccines losing potency,” she added.
The project also supports innovations designed locally or internationally that are affordable and can be used to reduce the risks of life-threatening complications during childbirth.
One of these innovations, that the MANI Project has funded the piloting of, is a device called the Uterine Balloon Tamponade (UBT) which is used to stop postpartum haemorrhage in several counties across Kenya.
Uncontrolled bleeding during and after childbirth is the leading cause of preventable death among women giving birth, according to the World Health Organisation. In Kenya, postpartum haemorrhage is the cause of around 30% of all maternal deaths.
The UBT was designed by Massachusetts General Hospital in the US, and costs less than $5 (£3.80). So far, over 8,000 UBT kits have been assembled in Kenya, saving hundreds of mother’s lives.
The MANI Project gives the example of Fatuma, a woman whose life was saved by one of these kits. In 2017, she was in hospital giving birth to her eighth child — and was still bleeding an hour after the birth.
The nurse on duty, Lucy Mwangi, was the only nurse at work that night due to a strike. She realised she could use the UBT device to try to stop the bleeding and it worked.
Fatuma, who is now a community health volunteer, later told interviewers that she had been against the idea of going to hospital for a birth but it saved her life.
“I am happy to be alive,” she said. “Though I’ve never encouraged women to give birth in health facilities, I am now converted and will champion for hospital deliveries because of this UBT.”
This story is part of a new series from Global Citizen called “UK Aid Works” — a collection of stories about health care development projects supported by Britain’s aid budget, collated by Action for Global Health UK (AfGH), an influential membership network convening more than 50 organisations working in global health.
In September, the Department for International Development (DfID) merged with the Foreign Office (FCO) to form the Foreign, Commonwealth, and Development Office (FCDO). At a time when the future of poverty-focused aid is under threat, it’s crucial that we hold onto programmes like these that focus on the world’s most vulnerable people. These stories are about the types of initiatives that we must strive to protect. You can check out more stories like this here — and call on the foreign secretary to ensure that aid is transparent and accountable here.