MATERNA HEALTH

By Venter Mwongera

A Question and Answer Session with Dr. Nancy Kidula, Obstetrician/ Gynecologist and she is currently with the World Health Organisation as the National Professional Officer in charge of Making Pregnancy Safer Unit.

WOMEN MUST NOT DIE WHILE GIVING LIFE!

Pregnancy and the subsequent delivery of a child is in most cases a joyous occasion. It is considered by many people to be a natural event and therefore taken for granted. However, we now know that pregnancy and childbirth and their related complications are the most common cause of death and disability in women of childbearing age (15- 49yrs) in developing countries. In Kenya, the most common cause of admission into hospital for females is pregnancy, childbirth and their complications.

What is maternal mortality?

Maternal mortality is described as the death of a woman while pregnant or within 42 days of termination of pregnancy or delivery from any cause related to or worsened by the pregnancy or its management.

What can cause death of the mother during pregnancy and childbirth?

In Kenya, most deaths of mothers during pregnancy and child birth are due to severe bleeding. After delivery a woman can die within two (2) hours if she bleeds excessively! Other common causes of death include high blood pressure (Hypertensive disease) in pregnancy; severe infection /sepsis especially after delivery; abortion related complications; and obstructed labor. Indirect causes of maternal mortality include HIV/AIDS, Malaria and anemia (lack of enough blood).

How frequently do mothers die?

Worldwide, a woman dies every minute from pregnancy related complications. In Kenya about 21 women die per day (approximately one every hour) as a result of pregnancy and childbirth. That is equivalent to a Nissan matatu crashing every day with pregnant women on board and all of them dying!

Can someone know if they will die from pregnancy?

Actually one cannot predict if it is them who will die as a result of the pregnancy or during childbirth.
How then can one prevent this bad event from happening?
Prevention of death from pregnancy and childbirth is quite simple.
Expectant women need to attend the antenatal clinic starting early before 4 months of pregnancy and make sure they attend clinic at least 4 times during the pregnancy period and as advised by the health worker. At this time, she will be checked and any problems diagnosed and treated early enough. Several tests will be taken and preventive measures and drugs provided. The woman will also be assisted to develop an individualized birth plan and trained on how to recognize danger signs during pregnancy.

It is also recommended that for the safety of the mother and baby, delivery should take place in a health facility and under the care of a trained professional.

Delivery by untrained personnel even though for some it may appear cheaper and more convenient has been associated with more deaths and disability.

After delivery, the mother and baby must be reviewed by a trained health provider within 48 hours of delivery (most deaths occur at this time). Any complications will be detected and treated in time.

Family planning saves life. Therefore for the safety of mother and baby, couples must plan how many children they will have, when to start the family, how to space the pregnancies, and when to stop child bearing. This will prevent the common problem of having children too early (before 18 years), too close together (recommended spacing is at least 2 years apart), too many (more than 4 pregnancies is risky for the mother’s health) and too late in life (above 35 years of age).

All these have been shown to increase the risk of death for both the mother and baby.
If women of child-bearing age and girls are to survive, then they have to delay pregnancy through use of contraceptives.

Research indicates that if adolescents delay pregnancy until after their 18th birthday, maternal mortality would significantly be reduced Spouses, families and communities must support the pregnant women by ensuring that they have adequate food, they rest enough, they have the funds and transportation to get them to the hospital in case of emergency, and they have the psychological support they need during and after pregnancy.

Everyone can contribute to this. Let us not allow women to continue to die while giving life!

Empowering girls through footbal

By Nkatha Mwongera



Daily awarding Judith Muhonja, the best player for the day

“Empowering girls through football and other life defense activities is the best thing that can be done to control the spread of HIV/Aids in the low income earning families in the Districts, Nation and the World at large.” Said Tausi Mohamed, District Sports Officer in Langata/Dagoretti.

*Kanungu lived with her mother and had twenty-three brothers and sisters. Some of her siblings had completed school and others were still in school. Her father had four wives and he passed away in 1999. He was sick but many of her children didn’t know what was ailing him but Kanungu knew that her dad had HIV/Aids.

Her mother was the fourth wife and other wives each had fife children but her mother had eight children, all of whom were married. Three of Kanungu’s sisters had moved to their husband’s home but two of them had a disagreement with their husbands and had returned.

They had four mad and grass thatched whereby every wife would put up with her children. Kanungu had to walk for two hours to the tap to fetch water. They had two caws, sheep and four goats. Kanungu did the normal domestic chores at home, like collecting firewood, cooking, washing clothes and looking after her elderly mother.

She baked half cakes sold for one shilling and hides them in between her books just to sell them at break so that she would get money to buy her school uniforms, sanitary towels, books, pens, food for her mother and her self. Her mother sold the local brew and it was Kanungu who would go to buy it from where it was brewed and bring it home to her mother who sold it to her customers at home.

When it rains in Kyeni, it pours. But the long rains in 2008 were particularly heavy. During those rains three of the houses in Kanungu’s home were destroyed by the pounding rainfall and al the families were forced to stay in the other two houses.

One brother whose house fell down left the home altogether to go to Nairobi to stay with another relative.

Kanungu finished primary education in 2009 and her brother supported her to train in suit and dress making. She was planning to buy a sewing machine after the training and set up her own tailoring business to earn a living.

Eight years after Kanungu’s father passed away, the relatives quarreled with them and they were asked to vacate the compound. The elder brothers tried to plead with step siblings but it was in vain. The mother and the three daughters moved to Kanungu’s elder brother rental house in Nairobi who sheltered them for only three weeks after which his wife threw them out.

Having nowhere to go and with no form of income, they moved to slums in Nairobi and both the mother and the two sisters remarried out of destitution.  

Life for Kanungu was too hard since she could not follow her mother’s example or sisters’ decisions to cling to any man for a plate of ugali. Her sister -in-law made it had for her brother to continue paying her fees.

Kanungu’s home gives a snapshot of the kind of situation a girl in any hardship or remote area in Kenya might find herself growing up in. It involves heavy domestic duties, helping to bring income to the family, parents surviving through tilling the land, brewing changaa or others involving themselves in prostitution and relying on older siblings who may have found employment away from the rural home in a town such as Meru, Embu or Nairobi.

While I am saying Kanungu’s story is  representative of rural and slum girls who hail from low income earning homes, many live in a complex World where circumstances within the homestead of each girl are contrasting and unique. *Mary living with her brother, away from her dad; *Lucy with both parents, who eventually broke up; * Jeniffer moves from one parent to the other and back again, away from her home in quest for an education; *Clementine and *Evelyn both having had to cope with the loss of their mother, Lilian looking after her elderly parents; *Sylvia’s close relationship with her mother; and Judith heading the household while her mother, a grocer works in town.

There is no typical family set-up in all poor families especially amongst the urban poor, all girls have universal experiences. Domestic work, work in their land and assisting to bring income into the family, all jobs that girls are expected to do including selling their bodies off to any man who has money just to make sure that there is food on the table for their siblings or elderly parents in spite of high prevalence of HIV/Aids.

Most of these girls who have taken on football as a sport activity to keep them busy, as a networking place, as a talent nurturing activity and as an opener to greater or a decent lifestyle to earn a living through this activity come from families that are fragmented, crumbling under the strain of poverty and illness.

In the light of the above facts about girls, Anthony Daily, formed an alliance called The Bravilian Queens Association (BQA) to reduce the vulnerability of adolescent girls in Nairobi slums through football.

Daily who is the BQA Chairperson said, “Playing football challenges stereotypes, increases self confidence, and creates a social network.  Importantly, integrated into BQA football activities is the teaching of life skills which includes assertiveness, knowledge of sexual and reproductive health and rights, financial planning, and entrepreneurship to these vulnerable girls.”

According to him, BQA was launched in November 2008 and it began as a football club for girls.  He said, “Our members come from Kibera and Dagoretti in the west, and Muthare and Kariobangi in the east.  We train at State House Girls High School field as it is centrally located and accessible from all areas of Nairobi.  Majority of players come from disadvantaged backgrounds.”

 He further added that empowerment of their members is their uppermost goal among their objectives and football and central to their activities, football has become an entry point to support poor teenage girls.

“The kind support of our sponsors, Safaricom, GTZ and VIHDA, has enabled us to start scaling up.  Eight existing girls’ football teams in Dagoretti have affiliated with BQA.  Selected members from each team have been trained on first aid, refereeing, coaching and peer education for life skills.” BQA Chairperson said.

 Daily further brought to light that each affiliated team plays in a BQA league, and with time, would run junior teams, creating opportunities for older girls to develop leadership skills, and providing younger girls with mentors and role models within their community.

He said that there are about 200 girls currently benefiting from Bravilian Queens activities and community service will be mainstreamed into their activities.

“Adolescent girls in Nairobi slums face numerous challenges including unwanted pregnancy, HIV and STI infection, malnutrition, and gender based violence.  In the Nairobi slums and low income earning families in rural areas, nearly 40% of girls under 15 say their best friend is sexually active.  Age of sexual debut is 3 years younger than the average in Kenya and the number of multiple sexual partners in Nairobi slums is 3 times higher than rural girls. HIV prevalence in Nairobi is above the estimated 7.4% national average, with young women being 4 times as likely as young men to be infected.” Daily, the founder and Director of BQA stated.

He said that girls also have to cope with traditionally deep rooted gender inequalities linked to gender based violence and financial disempowerment, hence, they need to be helped to overcome this inequalities.

 “Financial transactions relating to sex are common.  43% of adolescent girls in Nairobi slums say their first sexual encounter was coerced, 24% say it was forced.  Among 15-17 year olds, 19% have begun childbearing, more than twice the national average.  Research has identified unwanted pregnancies and the associated problems of abortion and infanticide as critical in Nairobi and in poor setups. But, data are scarce as abortion is illegal except to save the mother’s life.  Data suggests limited parental success in modeling positive life styles for their children due to poverty.  Unfortunately broken homes are the norm for many adolescents who increase vulnerability and high spread of HIV/Aids amongst young girls.” He emphasized.

To address these vulnerabilities, he said, “girls need access to formal education and additional knowledge and skills to create livelihood strategies and avoid high risk sexual behaviours; they need realistic life objectives to give purpose and direction, as well as opportunities to access resources. As the Bravilian Queens programme develops, it will include: Provide scholarships, both football scholarships to the US and scholarships to local schools; Life skills education involving reproductive health and rights, goal setting, assertiveness, critical thinking, financial and savings education and entrepreneurship; work experience and access to microfinance.”

According to Anthony Daly, Chairperson, BQA partner with specialist organizations when needed. For example, AMREF supports our life skills activities in order to maximize comparative advantage and promote and improve the lives of girls who are vulnerable.

According to Ms. Josephine Mwangi from the Ministry of Youth and Sports, “Girls and boys are equally created by God and any sport activity that they feel like participating to boost their self esteem and reduce vulnerability to all sorts of vices in the society, the ministry will and would always support them as we have been doing in the past.”

*Not their real names

By 'cutting' me, my mother killed my dignity

By Venter Mwongera                                                                       

The landscape is all green, hilly and a few clouds of smoke are seen at a distance. In the densely populated countryside, the fields are covered with green vegetations beneath the tall miraa (Khat) trees whose appearance resemble canopies of tropical rain forests in Latin America.

The houses are sparsely distributed and despite the fact that there are huge miraa plantations in these areas, many of the houses found here are muddy and are grass thatched. In most of the families in Ntonyiri Location, Meru County in Eastern Province; on average, every household has at least ten children.

The economic activity for people in Ntonyiri is miraa farming and this is their ‘gold’. In a day, one can fetch around fifty thousand on average hence they attach high value on their miraa plantations. The fencing is too tight such that even a passer-by cannot harvest a single straw of miraa to keep his mouth busy as they go about their businesses.

Ntonyiri is well known for its richness in miraa since it has the loamy soils which are wealthy in nutrients and are best suited for this crop to thrive well.  



As I cover around 5 kilometers to the interior parts of this place, I am overwhelmed by the serenity and the beauty of the area. I can’t explain how time has flown because my watch reads 2.00pm. I alighted from the matatu within their terminals at 9: 00 am to cover a short distance to meet my interviewee.

Meet Ms. Doris Kaari, a slender, chocolate face with deep dimples on her chins along with well cropped hair and a smiling face. Her dependable smile conceals a lot of frustrations that Kaari has been through.

Ms. Doris Kaari, who was circumcised by her own mother

Kaari shows me her hut where I sit inside to give her time to prepare and grant me an interview. Her room is well decorated with newspapers and magazines with different prominent people but when you study them keenly, each page has an educative or informative message.

When Kaari finally comes in, I ask her, who was pinning these newspapers and magazines on your house walls? She blushes and answers, “It’s me. I enjoy reading and when I come across any material that inspires me, I put it on the wall so that I can read it more often.”

We finally settle for an interview and she narrates to me her story amid tears.

“It was in 1998 early one morning when my mum took away my joy, peace and my self esteem.” She takes her handkerchief out of her skirt and wipes away drops of tears which were flowing on her smooth face like a water fall.

This really makes me nervous and I inquire from her if its ok we continue with the interview or we reschedule. She composes herself and confirms to me that she is fine we can carry on with the interview.

 “I hid here as a small girl in August 5^th, 1998 to elude female genital mutilation,” she says, pointing through the thick underbrush of the Ntonyiri forest, her quiet voice almost drowned by the swaying of huge miraa trees, “I was 5 and I remember we would have bags on our backs, we could carry sometimes 10 liters jerrican of water, sometimes 15, and we would throw them behind our back.” She demonstrates, crouching in the red dust and shuffling backward. 

“Sometimes my mother could be so close we couldn’t even rest on our way home – we would just carry on with heavy cans and keep going. If we were too slow we would, you know, be punished seriously,” she says as she squints one eye.

It was a cold morning and my mother gathered her sisters and my elder sisters to come and witness her barbaric acts on me. I had hardly taken my breakfast and there was no room for informing me what they had planned for me. 

One of my aunties grabbed me with her two hawk hands as my sisters watched calmly at our scene as it was unfolding. My resistance was futile because my aunt’s energy overpowered me.

I didn’t know that my mother was a circumciser till it happened to me. Without wasting much time, my sisters and other aunties unstrapped my skirt and shorts. My mum with her crude knife tore my inner wear and circumcised me. 

I could not really tell how it was done but it was at a lightning speed. I only saw blood flowing down my legs and heard ululations from the people who had come to witness my mother’s wickedness.

I was locked in the house for two weeks being fed like a small baby and during all these days, the guardians that I was with in the house never mentioned anything about schooling but their hot topic was getting betrothed to an elderly man who was rich and would bring wealth to my family.

By the time my mother and my elder sisters had decided to circumcise me, they had already found a man in his sixties to marry me off when i get to 7 years.

When I learnt about these little secrets, I could not help but I cried most of the time and I stuck with my education.

My people chose to frustrate me all through. Any time I came home for lunch after school, I could not meet any food left for me. My mother could unashamedly tell me that I should not waste time in school but instead get married to the man of their choice who had many herds of cows, big miraa plantations and would afford to take care of me.

Any money that was supposed to be paid to the school was a thorn in my flesh since this meant that I work extra harder to get it.

Day in day out was a struggle for me. I sneaked my school uniforms and books out of the house without my mother’s knowledge and during evenings, I would fetch water and firewood all alone as a form of punishment because I adamantly went to school. During weekends, I would clean clothes to earn a few shillings to buy books, pens, uniforms and pay activity fee since it was a requirement for all pupils in our school to pay. 

Occasionally, I could even dig other people’s shamba to finance my education.

By God’s grace, I struggled all through primary education and I managed to score 325 out of the possible 500 marks. I could not afford to pay for my secondary education.

I talked to my brother-in-law about my problems and he was happy with my performance despite the many challenges I had faced along the way.

Being a matatu driver, he couldn’t raise a lot of money to pay my secondary school fees but he made arrangements with the school authority on how he would be clearing my fees.

In February 2008, I enrolled in Maua Girls High School and as fate would have it, during April holidays the same year, my sponsor got involved in a head on collision with a miraa vehicle and he passed away before he got to Maua General Hospital.

That marked the end of my studies and my ambitions of being a lawyer one day were buried together with my brother-in-law. 

My life took a new twist and my parents’ prayers for my marriage were almost successful. My dad drunk with other old men and received many goodies in the name of cementing my relationship with them as their wife. 

I could not give up on education so easily. My only sister who sympathized with my situation is a grocer and she could not raise my school fees and provide for her children since she was now a widow.

I made up my mind not to concede to their plans and I have been working in different houses as a house help just to raise money to educate myself.” Kaari concludes.

Kaari is only one example of how female genital mutilation is being used to frustrate the efforts of girl child in pursuance of education.

Despite of the many anti- FGM campaigns by the governments beginning in early 1990s and a number of large NGO clearance projects, there are still millions of girls trapped by such practices throughout the countryside. 

These perilous practices especially concentrated amongst the Abagusii, Maasai, Marakwet, Pokots, Ameru; can result in many deaths in a day countrywide. The majority of today’s FGM victims are children who are below 10 years who cannot make decisions on their own and who often rely on their parents to make decisions for them despite pervasive female cut risk education campaigns.