Kilifi’s shelter of life

A real saviour of expectant mothers

With poor road infrastructure and the location of health facilities very far from reach in most rural parts of Kenya, a shelter next to a maternity facility where expectant women wait to deliver can come in handy. Expectant mothers who have experienced the maternal shelter at the Kilifi District Hospital that has been in operation for six years now can attest to this.

‘It is advantageous for me to be here because when I go into labour, my sister-in law will walk me to the maternity. If I was at home, I would panic and worry for the baby and for me. Here, I am near the doctors day and night,’ says Christine Mwagolo, an expectant mother at the shelter.

This ‘shelter of life’, from a distance, appears like a residential home. A small group of expectant mothers are seated on the verandah. They look radiant and relaxed. A few women, obviously not pregnant, are washing clothes and serving tea. They are birth companions.

The maternal shelter was built in 2004 with assistance from the Danish International Development Agency. The building is just 50 metres away from the hospital’s maternity unit.

It is a place where mothers at high risk of having poor pregnancy outcomes spend their last weeks before delivery. Jessica Deche, a nursing officer in charge of maternity at the hospital, explains that expectant women at the shelter include those who have had several miscarriages, have a low-lying placenta, mild pre-eclampsia or high blood pressure and those who have had two previous Caesarean sections. ‘All these women are likely to lose their lives or those of their babies should they to give birth at home,’ she adds.

The shelter also caters for women who live very far from a health facility. ‘An expectant mother who comes to the shelter two weeks to her due date will not be turned away,’ says Ms Deche.

Expectant women at the shelter are provided with food, a place to sleep and facilities to wash their clothes and bath. All the women also receive regular clinical reviews throughout their stay, at no charge.

The double-decker beds at the shelter allow a birth companion to sleep in the top bunker, as the expectant mother sleeps on the lower bunk, close enough to whisper for help.

All the women at the shelter have had problems during their pregnancy. Christine and Selma are veteran mothers with nine children between them, Janet is in her second pregnancy. The first one resulted in a stillbirth. Sarah, who is 19, is pregnant for the first time.

The women said they were advised by their doctor to stay at the shelter as soon as they got to their ninth month of pregnancy. Christine has left her four children under the care of her mother-in-law and her sister-in law is her birth companion at the shelter.

Selna says that she was anaemic and very weak and the doctor advised that she needed good food and close monitoring as she was carrying twins. She seems surprised at how well she feels. ‘I have not been given any medicine, but resting and eating well has been good for me. With five children, it‘s almost impossible to rest at home. There is always something to do. My legs were swollen and I was struggling to walk. Since I came here, I feel good. I had no idea that rest was all I needed,’ she explains. Her husband, who is taking care of their other children, visits her dally.

Recently, Public Health and Sanitation Minister Beth Mugo questioned the rise in the number of women dying at childbirth. Astounded by the statistics, Mrs. Mugo ordered a study on the reasons for declining maternal health indicators. Many reasons have been given as to why women choose to give birth at home. But often, women have no choice. They will give birth at home because they cannot afford hospital charges or live too far away from health facilities.

However, there are two main ways of preventing maternal mortality; ante-natal care and ensuring that every woman gives birth with the assistance of skilled professionals.

Building maternal shelters like the one in Kilifi is aimed at helping more women, especially those most at risk of dying during childbirth, to deliver in a health facility. The Kilifi District Hospital is able to house and feed the women at the shelter for free by using cost-sharing fees from other sectors. This indicates how much the hospital has prioritised reduction of maternal mortality.

However, this system of payment may not be sustainable In 2007, through the assistance of the United Nations Population Fund (UNFPA), a number of maternal shelters were set up in selected districts In the country. Whether these shelters have been able to sustain themselves would be of interest if maternal mortality is to be reduced.

When the women leave the shelters to deliver, they will have to pay maternity fees. A normal delivery costs Kshs700, an emergency Caesarean section costs Kshs3,000, while an elective Caesarean section goes for Kshs5.000.

For the poor rural woman, these costs are prohibitive and will keep most of her ilk away from hospital deliveries.

And although it breathes life to the community, the maternal shelter in Kilifi has not been used to its full capacity. One of the reasons for this Is lack of awareness of the shelter’s existence and its aim. The significant other is that husbands and mothers-in-law refuse to grant pregnant women permission to stay at the shelter.

The nurse in charge of the maternity agrees that the lack of social support plays a critical role in maternal mortality. ‘Even in the event where a pregnant woman’s life is in danger and she needs to stay at the shelter, she will be too scared to make that decision until she consults with her husband, ‘says Dorris Mwanzu , the deputy nurse in charge of the maternity ward.

Public health programmes that succeed involve communities that are aware of the benefits. In communities such as the one in Kilifi, male involvement will play a critical part in reduction of maternal mortality.

Fathers-to-be need to see the value of hospital delivery and the importance of mothers who are at risk spending their last weeks of pregnancy at the maternal shelter

The Selinas and Christines are from homes where women are valued and the unborn child looked forward to. You can see it in their faces. These are the good examples out there, but they are not enough.

Count the minutes you have taken to read this article. That is the number of women that have died unnecessarily from complications related to pregnancy around the globe.

END:PG46/48-49