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| Courtesy Google Images |
Sexual and reproductive health is a significant public health concern during epidemics, and safe pregnancy and childbirth can be a challenge in a country like Kenya where functioning health systems presents major challenges.
There has been little information from the government on how pregnant and nursing mothers can take care of themselves and their little ones during this difficult period when they are not only anxious about the pandemic but some, especially in the rural areas are facing reduced or no household incomes. Rural health centres are also struggling to provide safe antenatal and postnatal care during this crisis. The healthcare system has almost completely shifted its attention to patients afflicted with Covid-19, forgetting one of the most vulnerable section of the population, expectant mothers.
In May, 2020, Kenya reported its first case of an infant who contracted the Covid virus.
According to the Centers for Disease Control and Prevention, currently, they do not know if pregnant people have a greater chance of getting sick from Covid-19 than the general public nor whether they are more likely to have serious illness as a result. However, pregnant people have had a higher risk of severe illness when infected with viruses from the same family as Covid-19 and other viral respiratory infections, such as Influenza.
I have chronicled the journey and experiences of a pregnant woman and a nursing mother in a rural village in Kilifi County.
Susan, not her real name, is excited of having her second baby. She's five months pregnant. However, she is clouded with the anxiety and uncertainty of the ongoing pandemic. She and her family relocated to her rural home following her husband's forced leave from work due to Covid-19.
This means that she is separated from her gynaecologist in Nairobi and she's now facing new realities which have affected all her birth plans because of Covid-19.
Her last visit to her gynaecologist in Nairobi was on February 2020. Susan arrived in Kilifi on 31st March, 2020 and since then, she has had 2 neonatal visits at the local health centres. The first one was at the government owned Mtondia dispensary. She visited the facility two weeks after arriving in her rural home. She recalls this as her worst neonatal visit following the treatment she got from nurses at the facility.
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| Susan, five months pregnant |
Told to self isolate under a tree for 15 minutes
" My husband accompanied me to the dispensary. When we went in to register for check up, I gave the nurse my antenatal card. I had my height and weight taken. The nurse probed me and I told her that I had travelled from Nairobi and I had stayed here for two weeks and that this was my first visit at the center," she narrates.
She says that the nurse ordered her and the husband to go and self isolate themselves under a tree within the facility's compound for fifteen minutes before they could attend to her.
"No tests were taken. Even the foetus' movement and position that I had complained about to the nurse were not attended to. Whenever the nurse asked me a question, I had to shout because we sat far from her and I couldn't get inside. I felt so humiliated. The nurse's reaction was very condescending. She made me feel ashamed when really I shouldn’t be," Susan says.
"I do not know what to think of such treatment. The fact that we travelled from Nairobi, the epicenter of the virus, could be the reason the nurse was apprehensive to attend to me. But, why would a trained health professional act in such a manner? The nurse had put on a face mask and gloves. What if it was an emergency? Are there no guidelines to support health professionals to provide safe care for pregnant women considering that they are critical to the Covid-19 response for pregnant women? I keep asking myself, " she adds.
Told to return in a month
"There were four other pregnant women who were been attended to and the nurses attended to them more quickly and efficiently," she says.
Susan says that the nurse told her that she should return to the dispensary after one month. "The nurse told me that if I experienced any complications before then, I should rush back to the facility. I felt neglected and discriminated. Why would I go back after getting such bad treatment? " Susan asks.
Susan left the hospital without getting the service she went to look for. She walked out with a mosquito net and an infusion of antenatal iron-folic acid supplements.
"A neighbor had recommended that it's the best hospital in the community. I got out with a different impression, " she says.
Pregnant women decry lack of tetanus toxoide vaccine in the county
Susan was already late for her tetanus toxoide vaccine. This time, she went to a private clinic in Kilifi for the vaccine and for her antenatal visit. She was supposed to get the tetanus vaccine on 6/4/2020 but two weeks later, she had not gotten it. She had to wait until it was available a week later. Luckily, it was administered to her but she had to pay Ksh 200.
A lead study author Tami Skoff of the U.S. Center for Disease Control and Prevention (CDC) says that there is a "growing body of evidence that vaccination during pregnancy is effective at protecting infants from whooping cough in the early months of life, a period when infants are more likely to have severe or even deadly whooping cough infections."
But how are pregnant women expected to secure the safety and health of their infants when maternal vaccines are unavailable?
How are they expected to get the vaccines when it costs more than what they earn in a day?
Felistar Faida, 20, is a nursing mother. Her first and only child is 8 months-old. She attends clinic at the nearby government hospital. Her last visit was on 6/5/2020.
I ask her if she has received any guidance on how to take care of herself and her baby to avoid catching Covid-19? " I do not know how to take care of my baby to avoid getting infected. A nurse at the hospital told me not to get inside the hospital without putting on a face mask. I had to buy one to get in. While inside we have to sit a few meters away from each other. The nurse told us this is meant to avoid catching the virus. I have no information how to take care of my baby to avoid infection, " she says.
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| Felister carries her 8-month-old baby on her back |
Felister is among millions of young and vulnerable mothers in rural areas in Kenya who have no guidance from health authorities about providing safe care for themselves and their infants, whether they have suspected or confirmed Covid-19, or are asymptomatic.
Her husband has been rendered jobless due to the virus and they've been forced to cut down on meals in their home.
"Before Covid-19, we had three meals in a day. Now we survive by taking breakfast, skipping lunch and taking supper. The nurse said that breast milk is the best source of nutrition for my baby and that it provides protection against illnesses. But how is my baby supposed to be safe and healthy when I'm not able to afford a well-balanced diet? " asks Felister.
As health services become overwhelmed, sick children are less able to access care
Antonio Guterres, the Secretary-General of the United Nations has in the past expressed his concern over the plight of pregnant and nursing mothers during this pandemic.
"Reduced household income will force poor families to cut back on essential health and food expenditures, particularly affecting children, pregnant women, and breastfeeding mothers. As health services become overwhelmed, sick children are less able to access care. With the global recession gathering pace, there could be hundreds of thousands additional child deaths in 2020," he said
The plight of Susan and Felister, raises critical questions on the care of pregnant and nursing mothers during Covid-19.
Has the Ministry of Health developed a recommended guidance for the care of pregnant women and newborns during the Covid-19 pandemic? Are nurses scheduling regular home visits so that pregnant women do not need to come to hospitals often? Do health care providers who are handling pregnant women have Personal Protective Equipment(PPE)? Are maternity wards been equipped with enough beds, staff and medical supplies? Has the health machinery seen the need to focus on the emotional, mental, nutritional and physical well-being of pregnant and breastfeeding women, especially those from underprivileged backgrounds?
With this virus, I or my baby could get sick
Susan is due in August and though she had planned to give birth in the hospital, she's now having second thoughts about it after the bad experience. She is thinking of seeking the services of a traditional birth attendant to help her give birth.
"With this virus, I or my baby could get sick. I can't help but worry giving birth and raising my child in this uncertain times," says Susan.
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