Lilian Kaivilu @liliankaivilu
Nelly Achakulwa, a resident of Elwesero in Kakamega county, knows too well how perilous pregnancy can be. She, like many mothers in the country, opts to give birth at home due to limited access to health facilities and inadequte basic knowledge of reproductive health. Unknowingly, they increase their chances of maternity- related complications.
“I gave birth to my four children at home. The pregnancies were easy, hence I did not see any alarm,” says Achakulwa. However, for her fifth baby, she was forced to go to the hospital; her pregnancy proved to be difficult.
“I had very terrible back pains. I could neither bend nor stand, and for fear of further complications, I went to the hospital,” she says, adding that the back pains haven’t subsided since giving birth to her lastborn on March 19, 2019.
Priscilla Oparanya, Kakamega First Lady, attributes home deliveries to fear among most mothers. “Previously, most women did not give birth at health facilities for fear of insults from nurses.
As a result, they preferred the help of traditional birth attendants (TBAs),” she says, adding that with TBAs now serving as birth companions, home deliveries have reduced significantly. She is on track to ensure that all women give birth in a health facility, with the help of a skilled birth attendant.
The Imarisha Afya ya Mama na Mtoto, also called Oparanyacare, is a programme introduced by Kakamega Governor Wycliffe Oparanya to encourage mothers to deliver in health facilities through cash incentives.
Women in the county earn Sh2,000 when they give birth in a hospital, and get a similar amount every time they attend postnatal clinics.
Jessica Koli, the reproductive health coordinator, says the county now records 66 per cent skilled deliveries, a move she attributes to efforts by community health workers (CHWs). The programme is operational in 25 health facilities and targets needy mothers.
So far, 30,107 mothers in Kakamega county have benefited from the programme, with a total enrolment of 45,325 mothers. Koli, however, calls for more partnerships, especially in skills training for CHWs.
Magdalene Ingaji, a 22-year-old mother of one, delivered her baby at Elwesero health centre in Kakamega county after two days of labour.
“I was told I had long distress before being transferred to Kakamega Teaching and Referral Hospital, where I signed a form just before getting to the theatre. I did not know what it was all about,” says Ingaji.
Although everything was paid for under the programme, Ingaji says she prefers to be informed of each procedure performed. She is just one of the many mothers who lack basic information on medication and medical procedures they undergo while pregnant or during delivery.
Veronica Musieka, the reproductive health coordinator in Vihiga county, says healthcare workers must ensure that they inform mothers of every single step of the treatment.
“If you are giving a mother a certain drug, injection or undertaking a procedure, ensure you inform her. Also, get her consent before the procedure, after a proper explanation,” she advises. Even when administering contraceptives, Musieka insists on proper education beforehand.
“We always have counselling before we give the contraceptives. But the uptake of the commodities remains voluntary. What we do best is to ensure that we provide the key messages on presentation of pregnancy and family planning,” Musieka adds.
Just like Kakamega, Vihiga county has also seen an increase in pregnant women giving birth in hospitals, thanks to a similar maternal health programme, dubbed Ottichillocare, that encourages women to attend all antenatal and postnatal hospital visits as well as have skilled deliveries.
Currently operational in 21 health facilities in Vihiga, it has so far registered over 2,000 women. To improve service delivery under this initiative, the county also trained 180 healthcare providers on emergency obstetric and neonatal care.
Musieka says the county has seen about 800 mothers attend their fourth antenatal visit and 150 mothers giving birth under this programme. It has also paid about 900 mothers for first antenatal visits, 780 mothers for fourth visits and is in the process of making other payments.
Bernice Isangari, 31, is one such beneficiary. The mother of four delivered the first two children at home. “But for the third one, the pain was too much that I decided to give birth at a health facility,” she says.
Isangari, who is expecting her fifth child, joined the Ottichilocare programme late last year. Through the programme, she receives Sh1,000 whenever she attends antenatal clinics. “I have so far received Sh1,000 for each clinic visit. This money has helped me pay for transport to the clinic as well as buy fruits,” she says.
Vihiga county Governor Dr Wilbur Ottichilo is optimistic that the maternal and child health programme will ensure a healthier and more informed population.
“Through the Ottichilocare, I believe we will have mothers who are more informed about their health. The programme has also a component on family planning. Mothers have to understand the essence of family planning and the need for them to recover fully after childbirth. One of the goals of the programme is to encourage people to have small families that they are able to manage,” he adds.