Births by Caesarean sections fell by 26 per cent in one month following the doctors’ strike, raising fears about the state of maternal in Kenya, health data seen by Nation Newsplex shows.

In November last year, 13,300 women gave birth using Caesarean section, as opposed to natural labour. The following month as doctors went on strike that number fell to 9,800, a 26 per cent decline. This suggests that about a quarter (3,500 women) of pregnant women who would have accessed C-sections in public facilities were unable to do so in non-public institutions.

The analysis shows that the number of women who died in childbirth doubled nationally in the first half of 2017 to 857, compared to 413 in the first half of 2016.

Unlike wealthier women who sometimes elect to undergo C-sections, poorer mothers who need the surgery for medical reasons but cannot receive it are at increased risk of fatal complications during labour.

Four in five Caesarean sections performed in the first six months of 2017 were done in faith-based health facilities, a Newsplex analysis of service data recorded daily in the Kenya Health Information System also reveals.

Usually, it is the reverse, with over two-thirds of C-sections being performed in public health facilities. But at one point during the doctors’ and nurses’ strikes, cases in government hospitals dropped to zero, with faith based hospitals taking up most of the load.

Patients who needed to undergo the procedure, which is usually done in government facilities for free under the free maternity program, had to dig deep into their pockets or go without it. That could be either because they lacked money to pay for the service in low cost, non-public health centres, or because faith based hospitals lacked the capacity to handle the numbers of emergencies and birth complications.

With nearly half of Kenyans living below the poverty line and because only a third of Kenyans (31 per cent) have health insurance, according to a 2016 survey by Twaweza East Africa, cost is one of the major factors that keeps women from accessing health services.

According to the survey, the main insurance provider was National Health Insurance Fund which covers 88 per cent of the insured. Other options included insurance coverage from employers (14 per cent).

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With two-thirds of Kenyans having no health insurance, lack of access extends to other maternal and child health services such as family planning, antenatal care and vaccinations, with dire consequences. The analysis shows that the number of women who died in childbirth doubled nationally in the first half of 2017 to 857, compared to 413 in the first half of 2016.

Nationally, uptake of family planning services dropped by 14 per cent in the first half of 2016 compared to the same period last year.

But even before the strike maternal death rate in Kenya was already high at 362 maternal deaths per 100,000 live births, according to the latest Kenya Demographic and Health Survey (KDHS).

A C-section costs a facility a lot more than a normal delivery and requires, among other things, specialist personnel and an operating theatre. In FBOs, normal delivery costs around Sh10,000 and the C-sections cost about Sh20,000. But all types of deliveries are free in public facilities.

Most Kenyans opted for FBOs because private hospitals were way more expensive. In the more costly private hospitals, normal delivery costs between Sh40,000 and Sh95,000 while a C-section goes for between Sh140,000 and Sh220,000.

The nurses’ strike ended on November 2 after 151 days while the doctors’ strike that lasted for 100 days was called off in mid- March this year.

As the strikes persisted, St Mary’s Mission Hospital, Lang’ata, experienced an influx of patients. Many of the patients who sought treatment at the faith-based facility were pregnant mothers in the throes of labour pain, having been turned away in major government facilities, from the slums of Nairobi to Limuru and all the way from Thika, basically the Nairobi metropolitan area.

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