"The private healthcare providers located within the slums are not regulated by the government and many are illegal as they are not licensed," said Catherine Kyobutungi, head, health systems and challenges, APHRC. Kyobutungi said only 14.3 % of the health facilities were equipped to manage complications like eclampsia (pregnancy-induced hypertension). A key finding of the research was that a functioning referral system, vital in saving lives in cases of emergencies that require higher levels of care, was lacking in most facilities.
The APHRC research also showed that about 10% of births in the slums are handled by traditional birth attendants (TBAs). "These attendants lack skills to handle delivery and Kenya's National Reproductive Health Policy has banned them from assisting women during delivery," she said. She also noted that according to the research, Nairobi's largest public-owned delivery hospital, Pumwani Maternity, frequented by women from the slums, is choking under increased demand for its limited services. The hospital currently delivers more than 100 babies daily, with 128 being the highest number recorded in a single day. Lack of funding to recruit more medical personnel, buy vital life-saving equipment has made the situation worse.
According to the study, poor women prefer traditional birth attendants to nurses when seeking services. "The TBAs feel that they are offering useful services especially to poor women who are unable to afford high hospital charges arguing that many women prefer them to nurses in public health facilities because the nurses are abusive towards the women," Dr Kyobutungi said.
The study revealed that while most deliveries and abortions that eventually resulted in maternal deaths took place outside of a healthcare facility, the actual death happened at a healthcare facility. "This is a pointer to delays in recognising a complication, making a decision to go to a healthcare facility and reaching it or receiving care while at the facility," said Dr Kyobutungi.
The study noted that the cost of accessing maternal health services is a critical factor in seeking healthcare in Kenya. This is even more critical for poor communities, such as informal settlements, that live in abject poverty.
With regards to ante natal care services the research showed that overall, they are paid for in nearly all the facilities where slum women seek services, with only 16 % of the facilities not charging. This, the study noted was a big challenge in addressing maternal mortality related issues in Kenya.
