When birth ends in silence: Race to save mothers, newborns

At just 14, Brenda* from Zimmerman in Nairobi thought her swollen belly was an illness.

She had hidden the pregnancy for months, too afraid to tell anyone, until the day she walked into Pumwani Maternity Hospital after developing severe cramps.

Doctors at the facility quickly realised she was about to give birth. However, her haemoglobin was extremely low, at just 8.2, and her blood pressure was high.

The pregnancy was high-risk. To save her life, Brenda was transfused and wheeled into the theatre for an emergency C-section.

“I was scared. My heart was racing. I knew it was a matter of life and death,” she recalls.

She survived, but at 14, she had no knowledge of proper nutrition, had not attended antenatal clinics (ANC), and did not understand the importance of iron-rich diets, nor maternal health guidance.

“I used to have persistent headaches and fatigue, only to learn I had become anaemic. I didn’t know the importance of a proper diet during pregnancy,” she tells The Saturday Standard.

For Wolke Daiso, 21, survival came at a heartbreaking cost.

After labouring at home for six hours, she was rushed to Pumwani Maternity Hospital with a ruptured uterus.

Sadly, she lost the baby.

“I feel empty, but I thank God for saving my life,” she says. “I laboured at home under my mother’s care, fearing I would be subjected to a C-section at the hospital. Perhaps if I had come to the hospital earlier, my baby would be alive.”

On an adjacent bed is 20-year-old Melan Nafula, who shares a similar experience.

A ruptured uterus, emergency surgery, blood transfusion, and another baby lost.

“This is my third baby to die. I feel sad because I do not enjoy motherhood, even after carrying pregnancy to term,” says Nafula with teary eyes.

“I am scared of conceiving again. How, when I keep losing babies? What if I die from excessive bleeding that I face at birth. Pregnancy brings so much anxiety.’’

Inside the neonatal unit, at the facility, more than half of the 150 babies admitted are pre-term, fragile, tiny, and fighting for survival.

“Some suffer from anaemia of prematurity, others from severe jaundice or infections,” the unit's nursing in charge, Faith Njeru, tells The Saturday Standard. “Without timely care, many die”.

These stories mirror a national and global maternal and newborn crisis.

Globally, nearly five million children died before their fifth birthday in 2024, including 2.3 million newborns, according to the United Nations report.

As Kenya prepares to host a four-day international conference on maternal and newborn health from Monday, experts stress that the spotlight must remain on solutions that save lives.

Kenya loses 92 babies and 15 women every day to preventable causes, highlighting a public health crisis that demands urgent attention.

Ninety-two

Head of the Division of Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) at the Ministry of Health, Edward Serem, regrets that the deaths are alarming.

“Ninety-two babies mean parents are walking out of facilities empty-handed, most of the deaths are preventable,” poses Dr Serem.

“The deaths are unacceptably high. Why should mothers and newborns die before seeing their first yam. This brings discussions on how best, and intervention strategies that are working.’’

Many deaths also happens at community, reflecting a systemic gap that demands urgent action.

“How do we ensure no mother and newborn is lost. Do we have referral ambulances to save lives? It is worrying that we are witnessing referrals done on motorcycles, which have no oxygen to save lives, no health workers accompanying mothers due for delivery to hospitals,” says Dr Serem.

It is against this backdrop that Kenya is turning to the Every Woman, Every Newborn Everywhere (Ewene) initiative.

Ewene is a global maternal and newborn health framework designed to accelerate action and hold countries accountable for reducing deaths, and Kenya is among the first countries to adopt it. According to Emily Njuguna, a paediatrician and Africa Lead for Maternal and Newborn Health at PATH, the programme is a results-driven approach anchored on implementation and accountability.

High impact

The initiative aligns with global priorities led by the World Health Organisation (WHO) and partners, focusing on scaling up high-impact interventions that can quickly reduce maternal and newborn deaths.

It focuses on high-impact interventions, including early initiation of breastfeeding, infection prevention, management of prematurity, and quality care during labour and delivery.

“Ewene provides a platform where countries commit to reducing deaths and are held accountable for those commitments. Here, everyone gets care, regardless of where they are,” explains Dr Njuguna.

Serem maintains that Ewene plan to align with Sustainable Development Goals (SDG), focusing on equity and accountability to eliminate morbidities and death among mothers and newborns.

Through Ewene, the government is also rolling out a rapid results initiative, under the presidency, aimed at accelerating progress and ensuring that no mother or newborn is left behind.

Kenya’s decision to embrace Ewene comes at a time when progress in reducing newborn deaths has stagnated at 21 deaths per 1,000 live births.

According to the Head of Newborn and Child Health at the Ministry of Health, Julliet Omwoha, the leading causes of newborn death include birth asphyxia, prematurity, and sepsis.

Dr Omwoha says the Ministry is shifting strategy, placing quality of care at the centre of interventions, which includes strengthening skilled care at birth, improving neonatal services, and ensuring timely emergency response.

“If mothers receive quality care on time, then babies will survive”, Omwoha emphasises.

“For a long time, the focus has been on the mother. But under the Ewene approach, we are now deliberately programming for both the mother and the baby.’’

At the heart of Ewene is nutrition, which experts describe as foundational to maternal and newborn survival.

“Nutrition is key not only for the survival of a baby, but for thriving,” Njuguna emphasises.

While the government provides supplements such as iron and folic acid, experts warn that these alone are not enough, proper diet is key in pregnancy and child development.

But Laura Kiige, a nutrition expert at the United Nations Children’s Fund, says Kenya faces a triple burden of malnutrition, namely under-nutrition, micronutrient deficiencies, and a rising prevalence of overweight and obesity.

“About 42 per cent of pregnant women in Kenya are anaemic, contributing to nearly 20 per cent of maternal deaths,” says Kiige.

Progress in reducing child stunting from 26 per cent in 2014 to 17.6 per cent in 2022 has been uneven, with vulnerable regions still struggling.

In arid and semi-arid counties, dietary diversity is critically low.

For example, in Samburu, only six per cent of women consume the recommended number of food groups, while in Wajir it is 7.6 per cent.

“This is driven by persistent drought and limited access to diverse foods, leaving women highly vulnerable to micronutrient deficiencies,” explains Kiige.

Poor nutrition during pregnancy has far-reaching consequences; for example, malnourished women are more likely to deliver low birth weight or pre-term babies, both leading causes of newborn deaths. It also fuels an inter-generational cycle of malnutrition, perpetuating vulnerability across generations.

“Nutrition is the starting point. If we get it wrong during pregnancy, the impact lasts a lifetime,” emphasises Kiige.

Antenatal care

She notes that teenage pregnancies are particularly high-risk, as the growing mother and unborn child compete for nutrients.

Many adolescents delay seeking antenatal care due to stigma, worsening maternal outcomes.

“To tackle the crisis of mothers and babies dying, a comprehensive, system-wide approach is needed, including scaling up multiple micronutrient supplements, fortifying staple foods, using community health promoters to detect malnutrition early, and providing social protection such as cash transfers to improve dietary access,” says the nutritionist.

Under Ewene, nutrition is not a stand-alone issue but a core pillar in reducing maternal and newborn deaths.

In drought-prone counties, Ewene-linked interventions are already helping identify and treat malnourished pregnant women early, preventing severe complications.

Efforts now focus on sustainability, integrating nutrition into county budgets and the Social Health Insurance Fund.

Further, experts and the ministry emphasises on the need to increase budgetary allocation to improve maternal and child health.

Serem admits to funding gaps, emphasising that whereas funding for healthcare is largely devolved, the national government retains the mandate to procure essential drugs and commodities, an area that should be strengthened to avoid stock-outs and service disruptions.

Nevertheless, the ministry is collaborating with partners like the United Nations Children’s Fund (UNICEF) to improve the training of health providers and supply commodities.

Other solutions include the installation of oxygen in hospitals, the supply of sip-up machines for newborns and the supply of emergency commodities.

Globally, an estimated 4.9 million children died before their fifth birthday in 2024, including 2.3 million newborns, according to the latest report by the United Nations. Most of the deaths are preventable with proven, low-cost interventions and access to quality health care.

According to the report titled ‘‘Levels and Trends in Child Mortality’’, under-five deaths globally have fallen by more than half since 2000.

While child deaths have dropped by more than half since 2000, the pace of progress has sharply slowed since 2015.

Health experts now warn that without urgent action, gains made over the past two decades could stall or even reverse.

Newborns account for nearly half of all under-five deaths, highlighting gaps in care around pregnancy and childbirth.

The leading causes include complications from pre-mature birth and difficulties during labour and delivery, alongside infections.

“These are largely preventable deaths,” said WHO Director General Tedros Adhanom Ghebreyesus. “We must protect essential health and nutrition services and reach the most vulnerable families.”

Major killers

Beyond the first month of life, infectious diseases remain major killers, with malaria, pneumonia and diarrhoea leading the list.

Malaria alone accounts for 17 per cent of deaths among young children, with the burden heaviest in sub-Saharan Africa.

Sub-Saharan Africa accounts for 58 per cent of all under-five deaths, while regions such as Europe and North America record significantly lower mortality rates.

Chief of Health at Unicef Kenya, Luigi D’Aquino, says Unicef is working towards amplifying maternal and newborn health as a human rights issue and as an organisation, it is working towards supporting efforts to avert preventable deaths.

‘‘Any death in a mother or a newborn is one death too many. We have the knowledge and science to avert these deaths. To achieve SDG targets, acceleration is required by all stakeholders.

This can be achieved if there are investments that translate into the provision of respectful and quality health service,” says DR D’Aquino.

According to D’Aquino, it is in families and communities where women are less educated, and adolescent mothers who are most affected by maternal and child deaths.

Further, he notes the importance of increasing domestic budgetary allocation for maternal and child health, community education, and empowering facilities in eliminating maternal and child deaths.