However, in Kenya, maternal mortality rate remains at disconcertingly high level of 488 deaths per 100,000 live births. This rate has almost remained the same since 1990 (Kenya National Bureau of Statistics and ICF Macro, 2010).
There are wide regional disparities in maternal mortality within the country, with maternal deaths representing about 15 per cent of all deaths to women aged 15-49 of about 6,000 to 8,000 pregnant women dying every year.
The difference in maternal mortality by county is considerable with the county with highest maternal mortality having 20 times that of the lowest. The ten counties with the highest number of maternal deaths contributed 55 per cent of total deaths.
The Kenya health policy target for a 50 per cent reduction in maternal deaths, based on the current maternal mortality ration of 488 per 100,000, gives a target of 185 per 100,000 child births by 2030.
Achieving this target rides on Kenya being able to devolve health service delivery rapidly and efficiently. A rights-based approach to service delivery focusing on the ten counties with the highest maternal mortality ratio; improvement in access and quality of maternal healthcare; and reducing the social barriers that prevent women from demanding maternal services, would contribute significantly to this reduction. This target is achievable if there will be improved economic growth and increased political will.
The levels of deliveries assisted by skilled birth attendants (44 per cent), completed recommended antenatal care (47 per cent) and contraceptive prevalence rate (46 per cent) have remained low; while the unmet need for family planning is still high (26 per cent).
Maternal mortality results from complications during and following pregnancy and childbirth, with most of the complications developing during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy. The major complications that account for 80 per cent of all maternal deaths include: severe bleeding (mostly bleeding after childbirth); infections (usually after childbirth); high blood pressure during pregnancy; unsafe abortion; and diseases such as malaria as well as HIV and AIDS during pregnancy. Most of these can be prevented if mothers are encouraged to attend antenatal care, deliver in hospital and improve uptake of family planning to reduce unintended pregnancies.
The policy on health fees stems from the campaign platform of the Jubilee Coalition, whose manifesto pledged to abolish user charges at public health centres and dispensaries and provide free maternal deliveries to promote greater health equity in the form of access to care.
This initiative is already showing some positive results with skilled personnel having increased to 66 per cent from 44 per cent a year ago based on District Health Information System (DHIS) data.
The Ministry of Health has also reported an eight per cent reduction in maternal deaths over the same period. For the programme to realise further success it is recommended that all public health facilities have the basic delivery room infrastructure and equipment, including sufficient number of beds and significant increase in skilled human resources. More attention needs to be given to the ten counties accounting for the highest number of maternal deaths. Strengthening the health system and improving quality of healthcare delivery is pivotal to reversing the trend of high maternal mortality.