Tradition Vs. Modernity: Kilifi Mothers’ Dilemma Amidst Persistent Infant Mortality Rates

By James Odhiambo

Email, thecoastnewspaper@gmail.com

For Miriam Keya of Rabai, life has never been the same since her first child died due to a birth complication.

“It was the most traumatic experience of my life,” she says, her voice filled with grief.

“I was looking forward to becoming a mother for the first time, but instead, I lost my baby.”  

She remembers that fateful night when she started experiencing unbearable labour pains.

Unfortunately, her husband Wilson Keya was not around. He was working the night shift as a security officer at a local manufacturing company in Kilifi town when Miriam called him to inform him about the worsening condition. 

“Her voice was filled with panic and pain. I rushed home and found her laying in a pool of blood in the living room,” narrated Keya.

From the look on everyone’s face, something was wrong. The midwife told me the baby was tangled by the umbilical cord and died while she was busy cleaning Miriam after delivery.

Miriam is among many women in Kilifi who still face the dilemma of choosing between home and hospital births.

In a county where health facilities are inaccessible, expensive, and mostly limited by culture, many women have lost their children at birth, sparking major concern.

In the Giriama community, traditional birthing practices are deeply embedded in their cultural identity and are seen as a rite of passage. 

However, these methods can sometimes be dangerous, particularly when unprofessional and unskilled midwives are involved.

According to data from the Kenya Demographic Health Survey 2022, there has been only a reduction of a mere 0.5 per 1,000 live births in infant mortality rates. 

In Kilifi, the comparison between home births and hospital births reveals a significant disparity in child loss rates.

Approximately 150 children are lost due to complications arising from home births, while hospital births result in a much lower number of about 30 child losses.

This substantial difference highlights the critical need for more mothers to choose hospital deliveries, which offer safer outcomes for both mothers and infants.

Over the past decade, Kenya has struggled with high maternal mortality rates of 400-600 deaths per 100,000 live births, hindering progress towards Millennium Development Goal 5 on maternal health. 

In Kilifi County, these challenges persist, with 362 maternal deaths per 100,000 and 31 infant deaths per 1,000 live births reported at Kilifi County Hospital. 

Efforts by local authorities and health organizations, including KEMRI Wellcome Trust and Aga Khan University, have not sufficiently reduced infant mortality, influenced by cultural and economic factors like poverty and unemployment.

To address this, county health workers initiated the “Maternity Open Day” to raise awareness and tackle these issues. 

“Our tradition is a great challenge. We rely on midwives. We can consult her anytime for free, unlike hospitals, especially private ones, where we must pay more for consultations. As you can see, we are also fighting poverty,

The midwife lives nearby and listens to us even during odd hours. The hospital is far, and weekly visits can be financially exhausting,” Miriam laments.

*Challenges*

The chart shows the infant mortality rate as 31 per 1,000 live births and the maternal mortality rate as 3.62 per 100,000 births. Source: KCH

Kilifi County Hospital caters to up to 300 pregnant women daily, overstretching resources at the hospital’s maternity wing. 

Many of these women have resorted to hospital births and care due to the sensitization program dubbed “Maternity Open Day.”  

The sensitization drive has educated mothers of Rabai on the importance of regular medical checkups, precautions to consider during prenatal and postnatal periods, and the significance of maintaining a balanced diet, which is beneficial to both the infant and the mother. 

Mothers have also gained skills on what to do when labor pains start. Most importantly, the Rabai mothers are fully embracing hospital deliveries as they see it as a safer way than their usual culturally based deliveries, which are coupled with unskilled midwives that pose a high risk of infant deaths.

“It is very risky, especially when complications arise,” says nurse Saumu Juma from Kombeni Dispensary. “We often see cases where unskilled midwives cannot handle emergencies, leading to tragic outcomes. Over the past year, the number of women visiting hospitals for delivery in Kilifi has increased by 40 per cent, but many still face cultural and economic barriers to accessing hospital care.”

In Kilifi’s Rabai Sub-County Hospital, Ruth Mwadzayo arrives for her prenatal checkup and a community sensitization program thereafter. 

She has been visiting the midwife for the past six months of her pregnancy, and barely a week ago, she decided to attend the sensitization program on the importance of delivering in a hospital, organized by the Rabai Sub-County Hospital.

“The program is crucial for me because it has opened my eyes to the risks of home births and the benefits of hospital deliveries. I learned that in case of complications, the hospital has the necessary equipment and trained staff to handle emergencies, which gives me peace of mind,” says Ruth.

While the efforts through such sensitization programs have led to some reduction in infant mortality rates, the progress is still insufficient, as evidenced by the marginal decrease reported in the Kenya Demographic Health Survey. As the uptake of expectant mother increases, there is need for more doctors and midwives. 

“There is dire need for professional medical training for traditional midwives or a complete shift to modern healthcare,” says Dr. Eddy Nzomo, Kilifi Hospital Medical Superintendent.

“We are in need of support for maternal health care, as the number of women delivering in hospitals has increased three times in the last three years.”

Data from the Rabai Sub-County Hospital indicates that through the tireless sensitization programs being offered by the hospital and the Kombeni Dispensary at the grassroots level, the number of women who are now welcoming hospital deliveries is increasing, thereby tripling the number to about 85 per cent as indicated in the KDHS 2022 report.

“I remember being in Ruth’s position not too long ago. 

The pressure from my family and community to follow traditional birthing practices was immense. They kept telling me, ‘This is how our ancestors did it, and it worked for them.’ But after losing my first child to complications, I knew I couldn’t take that risk again,” Miriam says. 

“I tried to explain to the elders that times have changed, and medical advancements are here to help us and to not take away our traditions. It was hard for them to understand. 

‘Hospitals are for the rich,’ they would say, ‘We have our ways, and they are enough.’ It took a lot of courage to stand up and say, ‘No, I want to deliver my baby safely.'”

Health workers in Kilifi say to significantly reduce the number of deaths due to home deliveries, women, men and particularly traditional midwives need to be included in trainings and sensitizations to ensure greater care is adhered to.  

Dr. Nzomo emphasizes the potential of properly trained midwives in reducing these alarming rates.

“Training traditional midwives in modern medical practices can bridge the gap between cultural practices and medical safety. 

By equipping them with the necessary skills and knowledge, we can significantly reduce maternal and infant mortality rates,” he says.

This story was made possible with the support of the UZIMA-DS project, funded by the National Institutes of Health (NIH).