Addressing maternal health challenges through community-led human rights approaches
UNDP Kenya Amkeni Wakenya CSO facility: Spotlight on Pathways to Safe Motherhood Project, Marsabit
As one travels across Marsabit County, the most apparent characteristic of Kenya’s second largest county is the sparse population and the emptiness of its vast, arid lands. Coupled with a history of inter-community conflicts and a myriad of challenges such as harsh and unpredictable weather patterns, high levels of poverty, lack of access to health services, food insecurity among others, Marsabit presents a distinct development challenge to the communities living in the area, the National and County Government planners; and, other stakeholders.
One of the major issues affecting women in this county is inadequate access to maternal health services and information. At 1,127 deaths per 100,000 live births, Marsabit County’s maternal mortality ratio (MMR) is c.3.1 times that of the Kenya country average (at 362)., Thus, in June 2019, almost 60 people — young and old, male and female alike — gathered at a public engagement forum in the centre of Marsabit Town to listen and contribute towards what is being done to change the situation.
Maternal mortality has an acute human cost and heavily impacts the well being of society. Pastor Waqo Huda Guyo knows this far too well, having lost a close friend and neighbour during childbirth, and, his wife due to complications following the birth of their son. Finding sustainable solutions that can help to address preventable maternal deaths could help families like his to find closure following such tragedies.
For my case, my wife gave birth safely, the child is alive, a baby boy. But after childbirth, she bled excessively, and there was no blood at the hospital, why don’t the relevant people take a necessary step to maybe to acquire blood from other hospitals? I see there is great negligence in this sector, in our area. — Pastor Waqo Huda Guyo
Contrary to the common challenge of proximity to medical facilities that faces majority of the rural pastoralist communities, Pastor Waqo’s family home was just a few kilometres from Marsabit Referral Hospital: inadequate access to blood for transfusion following the birth of his son resulted in the death of his wife. Chief Hussein Charfi of Marsabit Town notes that the nearest blood bank, is in Embu County, almost 350km away — and even when blood is received from Embu, it can only be stored for a few days.
In addition to Marsabit’s complex health and social challenges, cultural practices such as Female Gentile Mutilation (FGM) are also contributory factors to the county’s high MMR. Female Gentile Mutilation is still the norm for most young women in this region and an enormous challenge for behavioral-change health interventions. Madam Nuria Gollo, an advocate for women’s rights and access to justice in Marsabit, says women who have undergone FGM are at high risk during childirth:
When a woman undergoes FGM, the vulva does not expand automatically, and it needs cutting during childbirth. Young women who have undergone FGM are cut to expand their vulva every childbirth. Some become anaemic — as they do not have a balanced diet meals and the food is always in small portions — so by the time they are in labor, they have no energy to deliver normally. They have to deliver through caesarean — and the biggest challenge is, the blood bank here is always empty. — Nuria Gollo
Creating awareness on the adverse impact of FGM on young girls and women is one of the steps towards promotion of maternal health. In a County where many rural women are uninformed of their Maternal Human Rights (MHRs), advocates like Madam Nuria are helping to increase access to informaion and influencing transformative change in maternal health services, including prenatal and postnatal care.
Pathways to Safe Motherhood Project, an initiative managed by Saku Accountability Forum (SAF), a local CSO, aims to bridge the gap between the County’s health facilities and its largely rural, pastoralist population to reduce the prevalence of maternal mortality. Specifically, the project intends to strengthen access to MHRs in Sagante/Jaldessa ward by sensitising communities through training of paralegals. To this date, the project has trained five paralegals, and expects to reach 5,000 women (15–49 years old) through household visits, community learning forums, and public outreach via broadcast and digital media. Over 2,000 people have been reached directly and are more informed about MHRs through the project’s interventions.
“The community’s response has been positive, they believe that local civil societies are more than empowering the lifestyle of our community as a change agents. They have owned the process and appreciate the work that we are doing. — Ms. Habiba Ailo, Paralegal, Pathways to Safe Motherhood
From the public engagement forum, there is recognition that more needs to be done about maternal mortality in Marsabit, and the goodwill to support this change is evident, based on the passionate presentations from the community elders, government officials and county representatives.
The Pathways to Safe Motherhood Project is run by Saku Accountability Forum, and funded by the Embassy of the Kingdom of the Netherlands under the UNDP Kenya Amkeni Wakenya CSO facility, which aims to increase access to justice for the poor, vulnerable and marginalised.
Disclaimer: This story is based first person reports and interviews conducted during a public participatory forum held in Marsabit County, June 2019. The opinions expressed in this story are solely those of the interviewed participants at the forum, and do not necessarily represent the views of affiliated donors or organisations.
Compiled by: Nicholas Wilson
For more information on the Pathways to Safe Motherhood project visit: https://www.facebook.com/Pathway2SafeMotherhood/
For more information on UNDP Kenya and Amkeni Wakenya CSO facility visit:
Kenya National Bureau of Statistics (KNSB), County Statistical Abstract — Marsabit County, 2015
Kenya National Bureau of Statistics (KNSB), Kenya Demographic and Health Survey 2014