A Price Too High to Bear
In Kenya, FCI and our project partners, the International Center for Research on Women (ICRW) and the Kenya Medical Research Institute/Centers for Disease Control (KEMRI/CDC-Kisumu), are conducting focus group discussions to explore the impact on the family of a woman’s death in pregnancy or childbirth. These discussion are part of a three-year research project that seeks to provide the first full accounting of the costs of a maternal death for families and communities: the direct monetary cost, the indirect costs in terms of lost productivity and income, and the “social costs” in terms of changes in household structure and responsibilities. This information will provide critical support for advocacy — in Kenya, in other developing countries, and at the global level — for improvements in the availability, quality, and utilization of maternal health services.
The blog post below, cross-posted from Perspectives: The ICRW Blog, is by Radha Rajan. Radha is an ICRW consultant with expertise in qualitative research and program evaluation, and a participant in these focus group discussions.
Ours is the only vehicle in sight on the bumpy dirt road to the village of Nyamula in Western Kenya. Compounds with semi-permanent houses set far apart from each other dot the landscape, and acres of farmland fill the spaces in between. I’ve come to this remote community to meet a few families who are reeling from an unexpected loss.
It’s quiet as we drive into one family’s compound situated miles away from any town center; the only sound is the bleating of a small goat as our jeep pulls to a stop. Before we leave the vehicle I ask my colleague from the Kenya Medical Research Institute (KEMRI) if a woman wanted to give birth in a hospital or at a clinic, how would she get there?
“After she goes into labor, someone may give the woman a ride on the back of their bicycle,” my colleague tells me. “If it is night, there is cell service and the family knows someone, maybe she can get a ride on a motorcycle. But that is often too difficult. Many women give birth at home.”
I picture a woman in labor faced with the options of riding a bike to the health clinic or delivering at home without the benefit of skilled medical care, and I start to understand the importance of advocating for increased funding to support maternal health. In women of reproductive age, maternal ill health is one of the leading single causes of death and disability. Each year about 358,000 women worldwide die from pregnancy-related causes, and most who die in childbirth suffer one of five preventable or treatable complications, such as severe bleeding. Recent reviews show that while the annual global number of maternal deaths declined by about one-third between 1990 and 2008, a large number of African countries, including Kenya, have made little or no progress in lowering maternal mortality rates over the past two decades.
Here at ICRW, we believe those figures can be reversed, and we’re working to illustrate, through research, the need for more investments to prevent maternal deaths. With the KEMRI/CDC Research and Public Health Collaboration and Family Care International (FCI) our latest research on maternal mortality aims to demonstrate the social, emotional, financial and practical burdens rural Kenyan families experience when a young woman dies during childbirth or pregnancy. Estimating how this combination of burdens – as opposed to just one – affects families and communities makes this study particularly unique. Ultimately, we hope our findings on the costs of maternal mortality will compel policymakers to take action so families can avoid another mother’s preventable death.
In Kenya, we are meeting poor rural families affected by maternal death to better understand their experience. We are collecting data on the financial toll they incur when they have to pay for emergency treatment and funeral services. And we’re learning how families already struggling to make ends meet are sent further into a cycle of poverty when they lose a productive member of their household.
While I was in Nyamula, we visited a house where a woman died, leaving behind one child. The mother of the deceased used to take small jobs outside the home to earn income that helped offset household expenses. Now that her daughter is dead, she must look after her grandchild and cannot work outside the home. As a result there is less money to pay for daily expenses and less flexibility to earn the money the family needs.
The emotional strain of a maternal death also weighs on surviving family members. The same mother told us that since her daughter died she has relied on her school-age children for help with household chores. The children resent having less time to study. Furthermore, the mother also said that she is frustrated because she has to rush through cooking meals so that she can care for her baby granddaughter. She said she feels like she wouldn’t be going through all of this if her daughter were still alive.
Tragically, that mother’s experience is all too common in rural Kenya and poor communities worldwide. But this is more than just about just one mother or one family: ICRW’s study and other efforts striving to curb the rate of maternal mortality can contribute to alleviating ill health, poor education opportunities and poverty worldwide. For instance, studies show that a mother’s health has profound implications for the long term well-being of children – particularly girls – through its effect on their education, growth, and care.
There are solutions for Kenyan families and others around the globe. Maternal deaths can be avoided by anchoring health facilities in locations accessible to the poorest, more remote households. That way, women can easily take advantage of pre-natal, post-natal and other care. We also have to change social norms so that women – young women especially – are allowed by other household members to access this important care. And we need the political will – from health and finance ministries to donor organizations – to invest in these solutions.