The need for gloves for health workers assisting with childbirth may be obvious, but in Yala Sub-District Hospital in western Kenya, obvious does not mean available.

At the government-run health facility, serving about 96,000 people, there has been a shortage of gloves – and health personnel are overwhelmed.

“Are you going to send a mother away to buy gloves at night? We need to attend to her, but we cannot recycle gloves. At the same time we cannot touch blood,” said Eric Achira, nursing officer in charge of maternity at the facility.

People accompanying the woman are sent to buy gloves, but they often do not have enough money. Achira has on many occasions been forced to dig into his pocket to buy gloves and stock the maternity ward.

Kitale District Hospital, a higher facility and referral hospital, is nearly 180 km away. And it is also suffering a shortage of basic supplies such as gloves.

Where gloves are in short supply and women must buy them, some may be discouraged from seeking hospital deliveries, notes Monica Oguttu, executive director of the Kisumu Medical and Education Trust (KMET), a reproductive health organization working with communities in western Kenya.

As it stands, only about 41 percent of births in Kenya take place in hospitals under skilled birth attendants, according to government figures. A great percentage of births, particularly in the rural areas, are assisted only by traditional midwives who, besides not being able to deal with pregnancy complications, may lack equipment to perform clean deliveries.

“When health facilities are unable to provide basic supplies like gloves – and even syringes in some cases, we are simply telling women to seek services elsewhere. They end up with unskilled attendants, where they can die, adding to the already high maternal mortality,” Oguttu told IPS.

The national maternal mortality rate stands at 414 per 100,000 births, with parts of western Kenya such as Siaya battling rates of between 800 and 900 per 100,000, according to KMET.

Bring your own supplies

But efforts are under way to meet the need for basic medical supplies. For example, KMET has embarked on a pilot project distributing simple birth kits to pregnant women in Siaya, in western Kenya.

Popularly known as mama kits, each contains among other things a pair of gloves, cord clamp to tie the baby’s umbilical cord, sterilised razor, soap for hand washing and a polythene draper.

Women are advised to carry the kit from the eighth month of pregnancy, to avoid delays in looking for basic items when she checks into a health facility.

The kit is also handy in that some women may find themselves delivering at home, or on the way to hospital. The baby would then be delivered with safe equipment. About 2,000 kits have been distributed in Siaya, which has the highest maternal mortality rate due to infection, according to the latest government data available.

Roughly a billion dollars a year is spent fighting malaria. Using this money most effectively calls for a detailed understanding of exactly who is at risk – enter the Malaria Atlas Project (MAP).

The first global map of malaria since 1968 shows 53 percent of the population of the Africa+ region – which includes Yemen and Saudi Arabia – lives in areas of high risk. Credit: Malaria Atlas Project

Just as the Global Malaria Action Plan was adopted in 2008, development of a new tool to assess the intensity of malaria was coming to fruition.

The Malaria Atlas tracks the presence of the malaria plasmodium – the mosquito-borne agent that causes the disease – generating a geostatistical map (relating statistical data to geographical areas) from a constantly increasing number of surveys that meet required standards – 14,000 at last count.

It is the first global map of malaria endemicity since 1968. The strength of the the techniques used is that the map is continually updatable while allowing users a precise measure of uncertainty.

The map divides the globe into areas of low, intermediate and high risk of malaria, corresponding to the frequency with which plasmodium falciparum is found in the bloodstream of people in a given area. In the Africa+ region – which includes Yemen and Saudi Arabia – 53 percent of the population lives in areas of high risk, 30 percent in areas of intermediate risk.

Kenya’s malaria prevention efforts in and around the coastal town of Kilifi are instructive. Initially, the government only ensured availability of insecticide-treated nets through government clinics at a highly subsidised cost. But the fact that just a few could afford to pay the difference saw authorities in 2006 embark on a campaign to distribute the nets free of charge, as well as providing paediatric drugs in public hospitals. Malaria infection prevalence has since plummeted.

Prevalence in Kilifi and some areas of the coast now stands at only about one percent compared to almost 40 percent ten years ago, according to Snow.

Similarly, the health ministry in 2007 released statistics showing a reduction in deaths from malaria, as well as stipulating that the number of patients attending outpatient clinics due to malaria had fallen by 13 percent.

But though prevalence in some areas has declined, other regions of the country continue to record prevalence rates as high as 17 percent, according to information leaked to IPS from the 2007 National Malaria Indicator Survey.

The government has been distributing treated nets to pregnant women and children under five countrywide but now the initiative will scale up to ensure the wider population is covered. Malaria is estimated to cause 20 percent of all deaths in children under five, government figures say.

“Instead of giving nets to only children and pregnant women, we want to ensure that the entire household has access to nets; then we can begin to say we are moving towards universal coverage,” said Willis Akhwale, head of the Department of Disease Prevention and Control within the Ministry of Public Health and Sanitation.

But resources are a problem in achieving universal coverage of locally-appropriate interventions.

“For a very long time resources – financial and logistical support has been the challenge,” said Akhwale. Even though in the last five years there has been an increase in resources towards malaria control, from two million dollars in 2002 to over 60 million dollars in the current financial year, this is not enough.

“With the current resource levels, we are not able to achieve universal coverage. What we are achieving is really what we had set out to ourselves as targets; we had especially set out to target vulnerable populations,” he noted. He said about 100 million dollars is required to achieve the best impact throughout the country.

By Joyce Mulama
NAIROBI, Jul 17 2009 (IPS)

After years of delays, Kenya’s cabinet has finally adopted a draft National Land Policy (NLP), which is now awaiting debate in parliament.

'Women have been marginalised and unfairly treated when it comes to the issue of dividing property, including land.' - Opondo Credit: Justin Mwelu/IRIN

The adoption of the draft policy on Jun. 25 signalled the first step towards a blueprint on how land issues are handled.

Women’s rights activists have been following the process closely, arguing that the document needs to spell out radical measures to correct a legal framework that has denied women access to land and property rights.

More than 70 percent of agricultural labour is supplied by women, according to the government’s figures, yet just less than five percent of women own land.

Evelyne Opondo, a senior programme officer at the Federation of Women Lawyers – Kenya (FIDA) has written extensively on the gender dimensions of land rights in Kenya. Excerpts of her interview with IPS follow.

IPS: The draft NLP has finally been adopted by cabinet. What does this mean for women? Evelyne Opondo: If you look at the document, it recognises that women have been marginalised and unfairly treated when it comes to the issue of dividing property, including land.

For example, the NLP proposes a lot of changes to the Married Women Property Act of 1882, which is a remnant of the British colonial rule and is still the one in use to adjudicate over matrimonial property cases. It fails to protect women’s interest in matrimonial property if it is in the man’s name, regardless of whether the woman contributed to (paying for) the item.

Women have lost property including land through this law in cases of divorce, separation and even death of the man.

The NLP is saying that we need a Kenyan law that will address such injustices. It is also saying that we need to look at the succession laws and see where women’s rights have been violated.

Importantly, it notes that there are customary laws which have been used for a long time in Kenya; some of them are laws that have negated the rights of women. The draft policy recognises the need to do away with such laws.

IPS: How are you addressing cultural beliefs and patriarchal attitudes that women should not own land? EO: FIDA, in conjunction with other civil society organisations like the Kenya Land Alliance, has been doing a lot of public education and awareness campaigns. We have gone round the country to all the eight provinces disseminating the contents of the draft NLP.

And this we started in 2007. We are talking about the issues – be they gender or administration of land – and that is something we continue do until now.

The stage at which the land policy is right now, the buck really stops with parliament, not the public who harbour these attitudes. Because once parliament adopts it, that is final, it does not go back for any further review.

IPS: How do you ensure that once parliament passes the document, the suggested reforms in land laws will target the injustices to women? EO: We as FIDA have launched (in June) research we did on women, land and property rights in Kenya. In this research, we have identified the land problems women faced in this country. Having identified the problems, we then went to document the changes we need as a country to rectify the situation; and at the end of it, we have drawn up a bill, which we are calling the Land Property Bill.

One of the things the draft NLP is consistent about is the need to change land laws. And it identifies other gender issues that should be addressed within these laws. So we have taken steps and drafted what the law should look like when it comes to women and land.

The bill fits within the stipulations of the draft NLP, and we have shared it with the ministry of lands, whose head, the minister believes in reforms. It is something we are going to use for purposes of lobbying further and educating different sectors on what we mean exactly when we talk about land issues and injustices to women.

IPS: What measures are in place to ensure that draft NLP is not mutilated by Parliament as has happened previously to other instruments seeking to address other forms of gender inequality? EO: There is a possibility that Parliament may want to water down some of the strengths of the document or some of the parliamentarians may not be willing to let the policy pass. We are cognisant of that and we have been creating awareness among members of parliament, particularly working with the Kenya Women Parliamentary Association, but we are seeking to reach out to the wider parliament, especially through the committees such as the legal committee.

But also it is important to put the whole land question in context with last year’s post election violence and conflict. Because land was identified as a long-term issue that must be addressed in order for Kenya not to have repeat (the violence).

So we are hopeful that the parliament will treat discussions on the draft NLP with seriousness because if land reforms are not addressed, that means we are likely to go back to violence.

When they finally address the land issue, the women’s issue must be addressed at the same time because there is no way we are going to separate women’s issues from the wider land reforms. If we are going to tackle the land problem, then it is in the interest of everybody, politicians and others, that land reforms be instituted, without leaving behind women’s issues, just like the NLP indicated.

IPS: Can we celebrate that the NLP has made a first step? EO: Yes we can celebrate that the draft NLP will change the strength given to some of the customary laws, and other constitutional provisions that have denied women access to land and property.

But the key issue is implementation, because the policy is just something to guide how issues of land can be handled; it is not something that we can enforce. That is why the next stage is critical to us – we must have laws and they should come out categorically against these customs that negate women’s rights.

When this policy is passed, there is a lot of awareness-raising that still needs to be done for the general public, but also for the land boards, the magistrates to give out rulings based on what the new land laws. Remember the government officers that we will be working with, say in the land boards after the new policy comes to play, are the same ones that were in the old regime, so their mentality may not have changed.

Excerpt:

By Diletta Varlese, Terna Gyuse, and Joyce Mulama
SIRTE, Libya, CAPE TOWN and NAIROBI, Jul 3 2009 (IPS)

No gathering hosted by Libyan leader Moammar Gaddafi is ever dull, and the Thirteenth Ordinary Session of the African Union, concluding in Sirte, Libya today has not disappointed.

Will AU deliberations lead to stronger food sovereignty? Credit: Manoocher Deghati/IRIN

A surprise invitation to Iran’s Mahmoud Ahmadinejad, who is facing down massive popular protest over his disputed re-election as president, briefly threatened to overshadow the meeting, but he did not in the end attend.

The other source of drama was the renewed challenge to the International Criminal Court, on grounds that it unfairly targets Africans. With Sudanese president Omar al-Bashir (who has been charged with grave war crimes in Sudan by the ICC) a confident and welcome guest in Sirte, a proposal originating with Libya calling for non-cooperation of AU member states in the arrest or handover of ICC indictees was unexpectedly put forward for discussion.

As is customary, the meeting of heads of state took place behind closed doors, but signs of tension leaked out Thursday when Gaddafi briefly walked out of the meeting, reportedly frustrated by continued opposition to his dream to strengthen continental government through a “united states of Africa“.

There is general agreement that the AU will move towards greater integration, but few leaders are prepared to accede to Libya’s demands that this summit give powers over foreign relations, trade and defence to a new African Authority.

In contrast to recent AU summits, where civil society has been gradually gaining greater access to proceedings, few if any non-governmental organisations were present in Sirte.

Ruthpearl Ngángá, of the Agency for Cooperation and Research in Development, which works on issues of social justice from offices in 17 African countries, says non-governmental organisations found it very difficult to get documentation to attend, and warned that without participation by civil society, it will be difficult to gain wide support for implementing any decisions taken by the AU.

“African civil society participation and engagement in every summit of the African Union has seen them maintain significant influence in addressing decision makers on behalf of citizens of the continent. Their evident low participation and presence in Sirte makes it difficult to visualise African citizens actively involved in driving the AU agenda.”

And that engagement will be necessary if there is to be meaningful progress on the theme of this year’s summit: investment in agriculture for economic growth and food security.

Speaking from Nairobi, where ACORD and others organised a symposium on agriculture on Jul.2, Ngángá said Africa’s agriculture has been on the AU’s agenda previously, but only seven of the 57 African states are meeting pledges made in the 2003 Maputo Declaration which committed AU member states to spend at least ten percent of their budget on agriculture

“A key demand from civil society would be to focus on investment that increases countries’ food sovereignty – the right of its peoples to determine their own food and agricultural systems. It must focus on providing adequate nutrition for all its citizens, more than on increasing economic gain.”

South-South cooperation

A prominent guest in Libya was Brazilian president Luiz Ignacio de Silva, better known as Lula. He called for investment in family farming and the creation of jobs and higher incomes in rural areas.

“The Brazilian experience proves that productivity in small-scale agriculture and sustainability in food production are crucial to eradicate hunger. Investment in agriculture that will lead to job generation is the best means of ensuring a dignified living to our citizens,” he said.

The Brazilian Agricultural Research Corporation (Embrapa) established an office in Ghana in 2006, in response to growing requests for technical assistance from Africa. Based at Ghana’s Council of Scientific and Industrial research, the Embrapa office identifies research needs that are then worked on by Brazilian researchers. The office also organises training for African agricultural workers.

Lula also spoke in favour of Africa following Brazil’s lead in becoming biofuel producers, albeit without sacrificing food production.

“For that reason, I have commissioned studies for the implementation, in Africa, of a model farm in association with a pilot plant for ethanol manufacturing,” he declared.

Touching on the global economic crisis, Lula argued for changes to the world’s political architecture. He called for greater influence for the South in institutions like the International Monetary Fund and the World Bank, and criticised trade barriers and domestic subsidies by developed countries on agricultural products.

“Within the framework of the (Doha) Round, Brazil is going to grant access to its market, free from tariffs and quotas, to products originated in relatively less developed countries,” he declared.

He also sought African support for Brazil’s bid for a permanent seat on the U.N. Security Council and asked AU leaders to make a declaration against the coup that deposed Honduran president Manuel Zelaya on Jun. 28.

With a finely judged sense of the microclimate of an African Union summit, Lula spoke of a historic debt owed to Africa by the United States, Europe and Brazil with regards to the slave trade and colonisation, which he said was “impossible to settle from the financial point of view”.

Outcomes

Time will tell what concrete actions will emerge from this latest summit of African leadership. There is the prospect of strengthening the African Union’s peacekeeping force in Sudan and Somalia; the lifting of Madagascar’s suspension after formation of a transitional government there; and the deepening of a potentially fruitful partnership with Brazil on agriculture.

On agriculture, Ngángá offered this advice: “Increased investment in agriculture must include targeted investment in small scale farming, and in particular providing incentives to women small-scale farmers, building the entrepreneurship capacity of women to engage in agribusiness and grow cash crops, and ensuring that state investments in social protection, particularly those targeting children, are not sacrificed.

“Investing in agriculture goes hand in hand with addressing the marginalisation of entire sectors of African society.”

Excerpt:

By Joyce Mulama
KAMPALA, May 26 2009 (IPS)

On May 24, one of the leading advocates of Africa’s unity and liberation, Tajudeen Abdul Raheem, was killed in a car accident in Nairobi, Kenya.

Tajudeen Abdul Raheem: 'Don't agonise, organise!' Credit: Justice Africa

Tajudeen was renowned for his committed panafricanism, the directness of his intellect, and his ability to fearlessly pose the most difficult questions in a way that demanded answers.

Among his many hats, Tajudeen served as deputy director for the United Nations’ Millennium Campaign, which encouraged popular involvement in achieving the development goals the world has set as targets to achieve by 2015.

Commemorating his life and work, IPS republishes an interview conducted on the sidelines of the 2007 Commonwealth Heads of Government Meeting in Kampala, Uganda, in which he assesses Africa’s progress towards the MDGs at the half-way point.

IPS: Where has there been progress in Africa with the MDGs? Tajudeen Abdul-Raheem: When you look at specific countries there has been some progress, especially on education, child mortality and also HIV/AIDS. A country like Uganda now has free primary and secondary education, where millions of children who were not able to go school are now going to school. Malawi, Kenya, Nigeria, South Africa and Ghana have also made tremendous progress in providing free primary education, even though there are still many challenges.

A country like Malawi, which used to be among the poorest countries in the world, has dropped infant mortality by 30 percent; it is only second to Peru globally. Rwanda, which has just come out of genocide…is actually doing pretty well on a lot of these issues — including education, technology and women’s empowerment. It has more women’s representation in parliament than most Western countries. This shows (that) if priorities are set well and there is political will, it is possible to achieve MDGs.

IPS: Which MDGs are you most concerned about? TA: One of the biggest scandals in the implementation of MDGs, and one that civil societies and the media really need to focus on, are the MDGs in relation to women. Indeed, all MDGs are about women because they are the majority, and therefore real development cannot take place without full participation and empowerment of women.

If you look at many countries, because of providing vaccinations in time, mosquito nets and other interventions, there is a decrease in child mortality — like in the case of Malawi. But across Africa, the maternal mortality rate is scandalously high, and you ask yourself: if our children are living longer, why are our mothers dying?

MDGs need to be seen as an integrated platform to address maternal health. Many women die due to complications at child birth. Many more die as a result of lack of transport to access health centres. If you have to transport a woman in labour on a bicycle or carry her — literally — by the time you reach the centre she will have died.

Some of these centres do not have doctors, nurses or midwives, because we are losing a lot of trained medical staff to better pay and better working conditions abroad. To achieve MDGs effectively, we have to look at all these aspects.

IPS: To what extent have wealthy nations met their part of their bargain with helping achieve the goals? TA: They have written off debts of some countries. Studies have shown that where debt has been written off, and when you have a responsible government, debt relief can work. Malawi, Uganda, and Ghana are good examples where money that should have been used to service debt has been transferred into social and economic programmes.

But the biggest threat by the rich countries is the unjust nature of international trade. Africa loses as a result of tariff barriers, the dumping of cheap goods from the industrialised world and denial of access to its markets. Our farmers are using hoes to farm, they are not subsidised — while the European farmers are subsidised, yet they are the ones with tractors, and employ all sorts of modern farming methods. This is killing the capacity of our farmers to compete even locally.

It is important that the rich nations address this matter. If Africa does not achieve the MDGs, the reason will not only be internal but also external dimensions, because the rich countries are not collaborating, especially on goal eight (to “Develop a global partnership for development”).

IPS: Is there enough pressure to compel rich countries to honour their commitments regarding the MDGs? TA: Civil society has been active in holding international campaigns against the selfish interests of the West. It is critical for the world to realise that a threat to one is a threat to all, that the prosperity of the West is structurally linked to the extreme poverty of the South. It is in their own interest to make sure that we create a better world for all.

Excerpt:

By Joyce Mulama
NAIROBI, May 2 2009 (IPS)

Four years ago, a furious Lucy Kibaki, Kenya’s First Lady, marked World Press Freedom Day by storming the offices of leading independent publisher the Nation Group with her entourage.”

David Makali Credit:

She was outraged by the group’s portrayal of her dispute with a neighbour and seized phones and laptops in a demonstration of the low respect one powerful figure has for a free press.

Today the situation is little better. In Kenya and Uganda which are considered heavyweights in the region, continued backsliding in press freedom has threatened their democratic gains.

David Makali, chairman of the East Africa Editors’ Forum says, conditions in these two states set the pace for how other countries in the region handle press freedom. Hopes for a free press have been deflated with the continued existence of repressive media laws and heightened attacks on media outlets in East Africa.

In a candid interview with IPS, Makali shared his thoughts on trends of press freedom in the region.

IPS: How would you rank press freedom in East Africa? David Makali: I think East Africa is not very well-ranked in terms of press freedom. On a scale of A to E, probably East Africa is at C; not the worst, but not the best.

I think there is moderate respect for press freedom but that respect is not founded on any solid legal or political foundation. It is dicey and the media is vulnerable to sporadic attacks from predators such as politicians, private gangs as well as commercial forces.

These threats don’t seem to be relenting. They are actually getting worse, because the political systems in all these countries are not geared towards protecting press freedom as a fundamental policy.

As a matter of practice, governments in this region do not hold press freedom as one of the cardinal rights or freedoms that they need to guarantee for society.

IPS: What other factors have jeopardised media operations? DM: I am most worried about the corporate and commercial impact on the freedom and independence of the media. It is not visible but it probably the most dangerous threat that we have. It has taken over the position of government as a threat to press freedom.

Because of competition and the whole struggle for survival by media enterprises, they become susceptible to manipulation by corporate entities, and the integrity of the news can no longer be ascertained. You do not know whether what you are reading is motivated by corporate and commercial interests or the genuine public interest.

Then of course there is the second threat to press freedom which comes from non-state actors; either private citizens working in cahoots [with the state] or [government agents] disguising themselves as private but attacking the press, media houses and individual journalists anonymously.

We see that in Tanzania, for example, the attacks on MwanaHalisi [a weekly publication which was banned for three months in October 2008] which was unprecedented.

Museveni did the same in Uganda when he banned the Monitor just like that. We have seen [private television station] NTV- Uganda being put off-air for indefinite periods; attacks on the Red Pepper, attacks on the New Vision journalists [two independent Ugandan newspapers].

In Kenya we remember the hooded guys who attacked the Standard Group [a media house comprising newspapers and a television station], acting on the guise of private people aggrieved by the content of media houses, but in fact I think they are accomplices of the state.

IPS: What is your take on media laws in the region; is the situation getting better? DM: No. They are the obvious government threats to press freedom by virtue of their oppressive nature, and are being enforced on the media across the region to protect political interests or to prevent uncomfortable truths from being published.

IPS: The theme of this year’s World Press Freedom day is the “Potential of the media in fostering dialogue, mutual understanding and reconciliation”. How can the media be effective given the environment under which it operates in the region? DM: First of all, for people to begin demanding any responsibility from the press either in terms of achieving reconciliation, fostering unity, there has to be regard and respect for press freedom by governments. Governments cannot want to have their cake and eat it or societies for that matter cannot want to have their cake and eat it.

They must first give to the press what is theirs; freedom to practice, and then begin demanding of it certain obligations to serve the society in which they operate. If that can be guaranteed, then I think the media has a significant role to play because as we have noticed when there is conflict, the media cannot thrive.

IPS: Authorities have justified their actions by accusing the media of exercising irresponsible journalism. What are your thoughts? DM: There can be no press freedom without responsibility.

It is reciprocal and it is the bare minimum that should be expected of journalists that if you are given certain privileges, you need to reciprocate in terms of how you practice.

And journalists, media owners and practitioners need to give back to society ethical products that promote social harmony, development and peace.

It has come across since the 2007 election in Kenya that radio stations, especially broadcast media, incited ethnic disharmony. The jury is still out because no clear-cut evidence has been provided to link particular broadcasts with particular flare-ups or crimes. But the assumption is that the general conduct of the media encouraged ethnic disharmony.

I think the media in this country, in this region, need to reflect on their role and see how they can become agents of positive change and aggregate conflict rather than maximize on differences.

That calls for responsible editorship. So perhaps it is time to begin asking who are the decision makers within our media outlets, and there has not been sufficient regard of consideration given to qualifications of people who are in that crucial gate-keeping role.

From where I sit, there is clearly need to consider strongly some benchmarks for the gate-keeper role within all stations, all media outlets that are coming up, especially the vernacular stations where people have been appointed more for their ability, knowledge of folk-lore and ability to communicate in their vernacular languages than their capacity for ethical decision-making and editorial judgment.

That is the challenge that faces our media which must be addressed through thematic training and exposure to the code of ethics of journalism, so that we can have a reduction in the number of the incidences of unethical decisions and unethical broadcasts and content going out.

Excerpt:

By Joyce Mulama
NAIROBI, Mar 4 2009 (IPS)

Two understaffed and ill-equipped public clinics serving 600,000 people: it is in neighbourhoods like Dandora that the battle to reduce maternal mortality is won or lost.

Evelyn Mutio Credit:

Residents of this poor neighbourhood on the outskirts of Nairobi often have to rely on their own experience – or turn to quacks – for maternal care or any other medical needs.

Six years into the United Nations MDG deadline, Kenya is still lagging behind in reducing maternal mortality (MM) by three quarters by 2015.

A new health survey is due at the end of 2009, but six years ago the Kenya Demographic Health Survey reported the maternal mortality rate as 414 deaths per 100,000 live births. The UN target is 147 deaths per every 100,000 live births by the year 2015.

IPS spoke candidly with Evelyn Mutio, a retired nurse, who now works to provide quality care to the people of Dandora and beyond. Her private clinic, Mkunga Nursing Home, established in 1995, offers mainly reproductive health services to the deprived community – at rates lower than those charged in public health facilities.

IPS: The latest official figures for maternal mortality in Kenya are from 2003: Has the country made any progress since then? Evelyn Mutio: The situation has not changed since 2003. If it has, it is not for better, for the simple reason that not all of the deaths are recorded. There are women who go to the big hospitals, where deaths are recorded, but what about the ones who die giving birth at home?

Or those in the slum areas like here, where by the time I get to know that a woman has complications due to pregnancy, the community has tried to attend to her, causing a lot of delay in seeking professional help.

By the time they decide to take her to hospital, after deliberating which hospital they can afford, they start with my clinic, down down on the ground. But then they come too late, and I can not do what is needed; then I forward the case to Kenyatta hospital (Kenya’s chief referral hospital) or Pumwani Maternity Hospital (the largest public maternity hospital).

By the time they find the means to get there, it’s too late. Sometimes they come back to me and report, “When we got there we were told to go to the mortuary.”

IPS: So what do you think should be done? EM: It is important to increase the number of health care facilities and bring them closer to the populations and reduce costs or even offer free services so that people can access professional treatment in hospitals. The situation is even worse in the rural areas, like in Eastern Kenya, where I also work. Women with pregnancy complications die on the way as they walk miles and miles to access a health facility.

Not only should more hospitals and clinics be built, but they should be staffed with skilled health workers and equipped to handle complications, rather than referring patients all the way to Kenyatta National Hospital in Nairobi.

IPS: What other factors contributing to maternal mortality are you are worried about? EM: I am also worried about deaths caused by unsafe abortions. Women and girls can be pregnant and people do not know, because they are hiding the pregnancy for whatever reason. They do not want the pregnancy and must get rid of it. They will do anything to terminate the pregnancy.

Sometimes they come to us and say “I would rather die than carry the pregnancy.” These are the cases that worry us more. I am saying this because if a mother does not want the pregnancy, she will go silently to the backstreet or quack, have an unsafe abortion and then get complications.

Once she finds it is not what she expected, she is bleeding too much and may die, then she will shout- and because we are nearest to the community, she will be rushed here. Then we can give the treatment, stop the bleeding and save the life of the mother.

IPS: How widespread is this problem? EM: We have been getting between 20 and 30 patients in a month. The figure has gone down slightly. But unsafe abortions are happening and it is a serious problem that should be addressed because it contributes a lot to maternal mortality.

IPS: What are the challenges in addressing this problem? EM: There are so few health care providers, who know what to do. So we need more health care workers, first of all to create awareness among the community on how to avoid unwanted pregnancies. This information is lacking.

Also, information about the different kinds of contraceptives is crucial. The acceptance of some of the contraceptives is still very low. Like now we are trying to advocate for IUD (inter uterine device) which is a long term family planning method that is so easy to administer, and there is no risk of forgetting it like in the case of the pill. But a lot of mothers do not want to try it because they believe in myths such as it will lead to cancer of the cervix, or that the baby will get hurt when they decide to be pregnant.

Sometimes it is the men who complain that they are being pricked during intercourse and so they ask their partners to remove the device. The women come to the clinic and between them and us, we decide to say we have taken it out while actually we have not. When they go home, the husbands are happy and they come to us to say “thank us very much. Now I am not being pricked.”

So then you know it is all in the mind.

IPS: Is availability of contraceptives an issue? EM: Yes. Sometimes we get complaints that all the family planning methods are out of stock; they are not available in the government clinics. Since the government supplies us with some of the commodities, when they run out, we are also affected. And then we have to buy to give to our clients.

The government must ensure reliability of the supplies so that women do not miss their family planning options and be at a risk of getting unwanted pregnancies. It is this situation that may lead to unsafe abortions which comprise a third of maternal deaths.

Excerpt: