In our efforts to solve world problems, we have discovered all manner of things, some factual and sensible according to the dictates of science. Some have not been so sensible and attempts to unpackage their origin, how they play out and their effects on human life have not been clearly understood. According to the 2014 ICPD Global report by UNFPA, we have halved maternal deaths since 1994 but we still continue to lose 800 women daily across the world to maternal deaths. It is quite inconceivable that we lose women due to pregnancy related causes and during childbirth in a highly digitalized world. While we are at it, it would be important to point out that a third of these deaths are due to unsafe abortions. For example in Kenya where I come from, from the 21 women who die daily from maternal deaths 7 women lose their lives daily due to unsafe abortions.
I will delve right in and explore how some of these unconventional issues have defined maternal mortality rates and continue to contribute to unnecessary maternal deaths…this I say cognizant of the fact that there are no necessary deaths.
Growing up as a young girl, we would always make jokes telling each other to stop asking “clinic” questions, in this context the word clinic questions was used to illustrate questions women are asked when they seek ante natal and/or post natal care. I earlier indicated of issues that fundamentally affect our lives but no one delves into them. In this regard all girls our age would tell you to stop asking us clinic questions because the perception of the questions asked at the clinic when women were pregnant are offensive and breed discomfort. There are many ways to explain this. I will start with what comes to the top of my head; having been raised in what is deemed as a conservative environment, questions and issues regarding sexuality would elicit mixed reactions of shame, embarrassment and awkwardness. Secondly even nurses and doctors given this culture of muffling up of sexuality issues would be forced to find suitable language to communicate to their patients in a suitable language. It seems like the “suitable” language was still not mutually agreeable to both parties.
Another explanation would be the hostile and tense relationship between health care providers and women who seek reproductive health services. Growing up I have heard all sort of stories, women admonished during their scheduled ante natal visits, abuse and harassment during child birth, forced family planning injections or simply one not consulted or given options but instead health care providers decide what family planning method one should use. These accusations might sound farfetched but in 2014 Kenyans were treated to the sight of a woman who gave birth on the hospital floor after a nurse refused to attend to her but instead hurled insults at her.
In 2014, UNFPA Kenya and other partners circulated the list of 15 worst counties for a pregnant Kenyan woman to be in. In these counties, the chances of a women dying from pregnancy or during childbirth are highest compared to any other county in Kenya. One of these red zones was Wajir, a deep analysis of the situation by one of the media houses unraveled the fact that women in Wajir do not seek maternity services from hospitals because they cannot by any means be attended to by a male nurses or obstetrician. Funny isn’t it..but that is their culture and is non-negotiable as of now. In 2013 during the ICPD Beyond 2014 Human Rights conference, a participant from Peru shared of their cultural beliefs where women cannot seek medical services from health care providers donning white clothing because white is a grieving color and a symbol of death in their culture.
I have lost a friend to maternal death, Sabina was a beautiful girl, my friend who was intelligent, full of life with the promise of tomorrow and better life was starting to show in her. Growing up in a slum, being a bright student with bold dreams, no one or nothing could stop her, but something did stop her. At 17 years Sabina got pregnant with her first child, it was sad for all of us, because being a pregnant teenager in the slum signaled the end of very many things. Sabina was on scholarship from being a bright student and this might not have been easy for her being pregnant, the first born daughter on whom the mother had very high hopes. To cut the long story short, Sabina did not go for any ante natal visits, during child birth she gave birth to a beautiful bouncy baby girl. But she died the next day from what doctors said was sepsis. Her daughter did not live to see her second birthday.
I am no doctor, but I strongly believe and I am somewhat convinced that ante natal visits would have averted the death of my dear friend. The moment the word clinic is synonymous to abuse is the moment we have lost the battle. When women tell each other to stop asking them “clinic” questions, it signals their attitudes towards the clinic and the fact that it is not a place any pregnant woman or mother of any infant want to spend any time longer than is absolutely necessary.
Center for Health and Gender Equality are conducting research on disrespect during child birth and this is a real issue whose interrogation should be done with all honesty. We know that a good number of pregnant women do not deliver in hospitals, in fact in Kenya only 67% of women deliver in hospitals. And this should be noted that the same percentage apply to women living with HIV, who are the most affected by the unmet need for contraceptives.
To #Endmaternaldeaths a trending topic on twitter by UNFPA, the above issues have to be addressed, we have to ensure culturally sensitive programs. Negative service provider attitudes should be dealt with and sexuality becomes an issue we discuss. We have to provide family planning to women and ensure we have youth friendly maternity services for young women and adolescents seeking these services.
The trend is impressive across the world, but more still remains to be done to ensure that no woman dies while giving life!!!!!!!!!!!!!!!!!!!!!!!!!!!!