Inside Kenya’s maternal health gap, the fight to save mothers and newborns

In Kenya, the difference is stark. A woman giving birth in Nyeri County is nearly nine times less likely to die from pregnancy and childbirth complications than a woman in Tana River and four times less likely than a woman in Samburu.

But what is Nyeri doing differently? And in Tana River and Samburu, how are health workers, county governments and communities working to close the gap?

Citizen TV travelled to the three counties to uncover the disparities, the challenges and the interventions beginning to make a difference, and to explore what lessons Kenya can draw as it works towards its 2028 commitment to end preventable maternal and newborn deaths.

In Sombo Village, Tana River County, Soba Adhan has become a lifeline for expectant mothers.

The calls he receives for pick-ups and drop-offs are unlike ordinary transport requests. His clients are pregnant women and new mothers travelling to health facilities for antenatal care, heading to maternity to deliver or returning for postnatal check-ups.

For many, Soba's boda ambulance is the crucial link between home and life-saving maternal care.

"Niko na kitabu nimeandika majina yao. Hakuna mtu anakosa clinic ama kujifungua nyumbani kwa hiki kitabu changu," Adhan said.

It is a noble initiative that the young man has sustained for 10 years, one born from a deeply personal story that began with his own birth

"Mamangu mzazi alikuwa amejifungua mimi, baada ya siku tatu akafa kwa sababu ya overbleed," he stated.

Soba works with traditional birth attendants to help mothers reach skilled care in time, a partnership aimed at reducing maternal and neonatal deaths in the community.

"Mama mzito ananikujia akiwa anatema mate, nakimbiza hospitali, nafanyiwa uchunguzi ajue hali yake ya pressure, malaria, alafu aanze kliniki. Akisikia uchungu ya kuzaa ananiambia, mimi naita ambulance," Fatuma Dulo said.

"Hata kama ni saa ngapi, niko na gari langu hapa, nakimbia, nakaa akijifungua salama, namrudisha nyumbani," Soba said.

"Amejitolea kutusaidia kina mama na hana malipo yoyote, tunamshukuru tu," Hadija Mohamed, a mother, said.

Tana River County is only second to Garissa County when it comes to maternal deaths recorded according to the Kenya Demographic and Health Survey of 2022.

The county records 586 deaths per 100,000 live births, which translates to about one in every 171 women dying from pregnancy and childbirth complications.

Samburu County shares similar arid and semi-arid geographical challenges with Tana River, but here too, communal efforts are changing the narrative for women and their newborns.

Beyond the hills lies Nongoiro Village. For women here, accessing maternal and newborn care means walking 10 kilometres to the nearest outreach clinic.

The midwives from Samburu Teaching and Referral Hospital have travelled another 40 kilometres to bring that care closer to them.

The terrain is unforgiving, but when the midwives and women finally meet, it is a happy reunion.

"Nilipata mimba, nikaanguka nikaumia, nikaenda Maralal. Nilienda Maralal, nikakaa miezi mbili huko, nikapata mahali mzuri wamama wanawekwa, nikakaa huko mpaka nikajifungua," Pinalek Maroro, a mother from Nongoiro Village, said.

A shaded tree may not look like a health facility, but here, it brings care closer to women who need it most.

It is part of a midwifery model taking maternal care from hospital to home and reaching women in some of Samburu's hardest-to-reach areas.

"Mahali kina mama wanatoka ndiyo wafike hospitali inachangia wao kupoteza maisha. Huu umbali hata tungehitaji ndege ya kuwasafirisha wakati kuna dharura," Lucy Makena, a midwife at Samburu Teaching and Referral Hospital, said.

"The nearest health facility is Loregejek, which is 30 kilometres from their village," Yazmin, a midwife at Samburu Teaching and Referral Hospital, said.

It is through such outreaches that women requiring extra care are identified and referred early to a maternal shelter at the Samburu Teaching and Referral Hospital.

This is Naitamany Lekolua. She has been at the shelter for two months. This is her seventh pregnancy. Her previous six pregnancies all ended in tears.

"Nimepoteza mtoto mingi sana. Wamesema niko na shida ya damu, hawezi beba mtoto kwa sababu damu yangu ni -ve," she said.

For the 32-year-old, it has been a painful journey. Now, with her due date near, she hopes to finally hold her baby.

The county says the maternity shelter gives women with high-risk pregnancies, especially those living far from well-equipped facilities, a safer place to await delivery.

"Between January and February tumekuwa na 55 mothers kwa maternal shelters na tunafurahi walijifungua salama na hatujapoteza hata mmoja," the Samburu County CEC for Health said.

A newborn unit at the Samburu County Referral Hospital is another investment giving hope to women in the ASAL county.

"In 2013 vifo za kina mama zilikuwa 1,000 per 100,000 live births, 2019 tulikuwa 350 per 100,000 live births na saa hii tuko around 275, na hiyo imetokana na juhudi ya kaunti kufikia kina mama kijijini na facilities yetu," the Samburu County CEC for Health said.

But Nyeri remains the standout county, with maternal mortality figures even lower than the WHO recommendation.

At 67 maternal deaths per 100,000 live births, roughly one woman would die for every 1,500 births.

So, how does Nyeri do it?

For starters, access.

Nyeri has 430 health facilities, 134 county government facilities, one Level 6 facility, and 296 faith-based or private facilities.

And despite being about seven times smaller than Samburu in land area, Nyeri's network of facilities puts care much closer to its population.

The average distance from one facility to another is three kilometres, apart from Kieni Sub-County, where the distance increases to five kilometres.

According to the Kenya Health Facility Census, Nyeri is one of only 12 counties out of 47 in Kenya that meets the World Health Organization recommended core health worker threshold, which demands a baseline of 23 doctors, nurses and clinical officers per 10,000 people.

But it is not just the number of health facilities and skilled health workers that is enviable.

Road access in most parts of Nyeri County is also strong, helping residents reach health facilities.

It is a model that, if replicated and adapted across the country, could fundamentally change the story for mothers and their newborns.

But for mothers in Tana River and Samburu, lasting change will require more than local interventions.

Better roads, financial protection and stronger referral systems could reinforce existing efforts to bring maternal and newborn deaths to zero by 2028.