By Zoe Alsop
Sunday, October 28, 2007
Kenya's maternal death rates are among the highest in the world, despite its relative prosperity, health care reforms and U.S. funding. Beatings of women in labor in hospital maternity wards are common, as are rejections of women without funds.
NAIROBI, Kenya (WOMENSENEWS)--On hundreds of nights over the past 20 years, taps on the tin wall of her one-room house pulled Joyce Atieno from her bed and into the muddy streets of Nairobi's slums to help another baby into the world.
In a city rife with predatory quacks and counterfeit pharmaceuticals Atieno, 38, was a trained birth attendant who gave her services for free. But not anymore.
"If somebody comes to me I just tell them no because there is no pay, nothing," she says. "I don't want to continue with the work again because I don't have the support from the hospitals."
She's been worn down by the indifference and outright cruelty, not on the streets of the famously violent Mathare slum, but in Kenya's health care facilities, where scandals and investigations of violence against women in labor have resulted in few improvements.
Her resolve broke in 2006, when one patient was turned away from a public hospital because she did not have the $45 deposit required for admission. Rushed to a private clinic, the mother was turned away again for lack of money. Kneeling in the mud outside, Atieno assisted the birth, tying the placenta with twine fished from the gutter. But it was too late. Both mother and child died.
Later that year, Atieno's 25-year-old daughter died on the doorstep of the public health facility where her husband worked. Administrators told Atieno they were not equipped to handle the complications and their ambulance was out of gas.
A July 2007 report by the Center for Reproductive Rights in New York and Nairobi's Federation of Women Lawyers document the extreme conditions in Kenya's delivery wards as well as the indifference Atieno describes. Women who arrived at hospitals without their own supply of anesthesia were stitched up without medication. Each year, hundreds of new mothers unable to pay fees are detained in health care facilities.
In one case, a male clinician who was supposed to stitch up a tear a woman sustained during delivery used his scissors to genitally mutilate her instead. (Female genital mutilation was outlawed in Kenya in 2001 but the practice persists and an estimated 38 percent of Kenyan women have been cut.)
Though two independent doctors, including one from the police department, confirmed the crime, Kenya's Medical Board found insufficient grounds for a hearing. So far, every complaint that the Federation of Women Lawyers has brought before the board has been dismissed as unworthy of further investigation.
Health officials and advocates gathered at the Women Deliver conference last week in London to focus international attention on maternal health complications, which claim the lives of 536,000 women each year, according to the World Health Organization. Of those deaths, 533,000 occur in the developing world and half of those occur in sub-Saharan Africa.
Many African countries lack the funding and health facilities to provide care for pregnant women. But Kenya, one of the continent's most prosperous, will receive over $500 million in health aid from the United States next year. Still, with 1 in 39 women dying in childbirth, it's one of the most dangerous places on earth to be in labor.
From 1974 to 2002, Daniel Arap Moi's government all but gutted health facilities. While politicians pilfered money earmarked for hospitals, unpaid staffers extorted patients and fenced stolen supplies and equipment to private outfits. By the time President Mwai Kibaki was elected on a platform of reform, most public hospitals were little more than shells sheltering demoralized and bitter employees.
Before she was dismissed last summer, Kenya's progressive health minister, Charity Ngilu, one of 14 women in Kenya's 224-seat parliament, managed to push through a bill waiving delivery fees for women unable to pay.
The new law doesn't apply to Nairobi's Kenyatta National Hospital and Pumwani Maternity Hospital, to which smaller facilities across the country send women with complications. Mothers who cannot afford $40 to $60 deposits must demonstrate they are too poor to pay, a lengthy process. Once inside the hospitals, it can be hard to get out again.
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