Pregnant women at risk of death in Kenya's COVID-19 curfew

Veronica Atieno remembers feeling her way through the dark alleys between the shacks that make up Nairobi's slums, picking her way past raw sewage and rusty, razor-sharp metal roofing with trepidation.
Her labour pains had crescendoed during Kenya's coronavirus dusk-to-dawn curfew, and there were no public or private means of transport to the hospital where she had planned to give birth. Fears of heavy-handed police enforcement of the curfew kept possible helpers away.

With time running out, her only option was to reach the home of a traditional birth attendant nearby, Atieno said. But she was scared.

“I had many concerns about the health of the baby if she was delivered by the traditional caregiver. How hygenic is her place? Does she have personal protection gear to prevent the spread of COVID-19? What if I need surgery?” she worried as her spasms intensified.

Her plight has played out every night for pregnant women across Kenya, putting some at deadly risk. That has inspired a local doctor to create an emergency service, Wheels for Life.

Kenya already had one of the worst maternal mortality rates in the world, and though data are not yet available on the effects of the new curfew, experts believe the number of women and babies who die in childbirth has increased significantly since it was imposed mid-March.

The concerns drove obstetrician and gynecologist Jemimah Kariuki at the government-run Kenyatta National Hospital to attempt a solution.

“When the curfew started we had open hospitals but no women, and we would hear reports of women delivering at home with very dire consequences: Women would come in the morning with babies who passed in the night or they had ruptured the uterus or had significant tears,” she said.

When one mother was reported to have died while in labour, Kariuki felt she needed to do something.

She shared her phone number on Twitter, asking women who needed to consult about their pregnancies to reach out. The tweet quickly went viral.

“The response was overwhelming, I was getting 30 to 40 calls from women telling me, ''I was anxious, I did not know what to do.'' In one week I had five mothers calling me like, ''I am in labor and I don't know what to do,” she said.

Kariuki started to track down vehicles to provide transportation to health facilities, but few were on the road because of multiple reports of police brutality while enforcing the curfew.

Human rights groups have reported at least 23 curfew violators allegedly killed by police, and videos have circulated of baton-wielding officers whipping people.

Kariuki reached out to companies and state organisations for support in providing free services such as transportation and medical personnel. The response was overwhelming, leading to the formation of Wheels for Life.

The Health Ministry, Nairobi University, taxi service Bolt and others pitched in to provide the free services.

“It is really amazing when you can see that people are willing to go beyond the economic gain so that they can help the less privileged in society, especially at a time of COVID when everyone is thinking about cutting costs,” Kariuki said.

Wheels for Life has a toll-free number which pregnant mothers call to be triaged and connected to a doctor. If a mother needs medical attention but it's not an emergency, a taxi is dispatched to take her to hospital. If it's an emergency, an ambulance is dispatched.

According to the United Nations'' Maternal Mortality Estimation Inter-Agency Group, maternal deaths in Kenya had fallen from 9,100 a year in 2000 to 5,000 in 2017. That translates to 13 recorded maternal deaths daily, down from 24. Still, the East African country remains among the top 21 in the world for maternal deaths.

Louisa Muteti, chair of the Midwives Association of Kenya, fears that mother and child deaths during childbirth have increased under the curfew.

Muteti said 68% of mothers who give birth in Kenya have access to skilled personnel. Others give birth at home using traditional birth attendants or by themselves, and when deaths occur they are not officially recorded.

Transport and security are the biggest challenges under curfew, Muteti said, especially in dimly lit informal settlements.

According to the World Health Organisation, women die as a result of mostly treatable complications during pregnancy and following childbirth such as severe bleeding, infections and high blood pressure.

WHO emphasises the importance of skilled assistance during childbirth, saying “timely management and treatment can make the difference between life and death for the mother as well as for the baby.”

Kariuki said Wheels for Life has handled 10,950 calls in the last 100 days while 890 women have been taken to hospitals for various issues with their pregnancies. 
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