OPINION: What the Christmas story teaches us about maternal care today

“And she brought forth her firstborn son, and wrapped him in swaddling clothes, and laid him in a manger — because there was no room for them in the inn.” — Luke 2:7

Every Christmas, we retell the story of a young, heavily pregnant woman turned away again and again. We speak of angels and carols, but we soften the hard truth: Mary of Nazareth was in labour, far from home in Bethlehem, vulnerable, and without a safe place to give birth. There was no room in the inn.

That line should trouble us. Because two thousand years later, “no room” is still one of the most dangerous things a woman in labour can encounter.

Globally, maternal death remains a quiet emergency. The World Health Organization estimates that about 260,000 women died from pregnancy- and childbirth-related causes in 2023— more than 700women every day. Almost all of these deaths occurred in low- and middle-income countries. Most were preventable. The causes are not mysterious: bleeding, infection, high blood pressure, and obstructed labour – conditions that should no longer be killing our mothers in the 21st century.

Kenya is no exception. Our maternal mortality ratio remains unacceptably high at about 342 deaths per 100,000 live births. But what should weigh most heavily on our conscience is when these women die. According to the Confidential Enquiry into Maternal Deaths in Kenya (CEMD) Report 2017, seven out of ten maternal deaths occur at night, on weekends, or during public holidays. The same pattern holds for newborns: between 50 and 70 percent of neonatal deaths happen during nights, weekends, and public holidays.

These deaths are not random. They follow predictable system weaknesses.

At night, wards are understaffed. On weekends, senior decision-makers may be absent. On public holidays, blood donations drop, transport delays increase, and referral systems slow down. Labour, however, does not respect calendars. Biology does not wait until Monday morning.

Mary’s story feels painfully modern. A woman who did everything right still found closed doors. No bed. No privacy. No skilled help nearby. She delivered anyway. Against numerous odds, she survived. The religious among us would say this was because she was delivering the Son of God.  Many women today often do not beat such odds.

In our hospitals, “no room” takes many forms: no bed in a crowded maternity ward, no blood in the blood bank, no ambulance for referral, no anaesthetist on call, no theatre team available at 2 a.m. As a specialist working in maternal and fetal medicine, I have seen these  far too often. A woman arrives after hours of obstructed labour. The team is stretched thin. Supplies are limited. Decisions are rushed. Sometimes we win. At times, tragedy unfolds  in the loss of a mother — or a baby — who should never have died.  

This is not a failure of compassion. Health workers care deeply. It is a failure of systems.

Globally, there is clarity on what works. Around the world, momentum is building to accelerate efforts to save the lives of women and newborns. Initiatives such as EWENE — Ending Preventable Maternal, Newborn and Stillbirth Deaths — co-chaired by WHO, UNICEF, and UNFPA, aim to ensure that no pregnant woman, mother, or newborn is left behind, regardless of where they live. The focus is deliberate: high-impact interventions, equitable access, and quality of care no matter the hour or the day. These international and local efforts offer a critical opportunity to pivot.

The lessons we have learned, as a country, confront us with an inconvenient truth. Most maternal and neonatal deaths are policy failures before they are medical ones. Countries that invested consistently in skilled birth attendance, emergency obstetric care, functional referral systems, and reliable blood services reduced deaths dramatically. 

The surprise is this: saving mothers does not primarily require expensive technology. It requires planning for nights. Staffing for weekends. Stocking blood for holidays. Treating childbirth as essential national infrastructure, not as an event that can be managed on goodwill and improvisation.

Christmas is a season of generosity and reflection. But maternal health cannot depend on seasonal concern. Compassion without preparation does not save lives. Reverence without reform changes nothing.

Two thousand years after Mary laboured with no room in the inn, no woman in Kenya — or anywhere — should still be told there is no space, no staff, no blood, or no help because it is night, a weekend, or a public holiday. How we care for women at the moment they give life is not only a health issue. It is a measure of our priorities, our systems, and our humanity.

Dr. Richard Mogeni is a Consultant Obstetrician & Gynaecologist, Chairman of the Kenya Obstetrical and Gynaecological Society – North Rift