Garissa, Mombasa among deadliest counties for mothers during childbirth

For many expectant mothers in Kenya, visiting a health facility is meant to ensure safety during childbirth.

But for women in counties like Garissa and Mombasa, entering a hospital can bring new threats, as revealed in a recent Ministry of Health analysis.

The study, conducted with support from key health partners, mapped maternal deaths and stillbirths across all counties from 2011 to 2022.

Its findings highlight sharp disparities: while some counties have made childbirth considerably safer, others continue to expose mothers and babies to alarming risks.

The report, titled “Trends in maternal mortality and stillbirths by county in health facility data, Kenya, 2011–2022”, appeared last week in the BMC Pregnancy and Childbirth journal.

Under the leadership of statistician Rose Muthee, researchers examined data from the Kenya Health Information System (KHIS) and the Maternal and Perinatal Death Surveillance and Response (MPDSR) to understand patterns of maternal mortality and stillbirths in health facilities.

Overall, the results show modest gains alongside persistent challenges. Maternal deaths in facilities fell from 132 per 100,000 live births in 2011 to 97 per 100,000 in 2022, while stillbirths dropped from 24 to 16 per 1,000 births.

Yet since 2018, these improvements have plateaued, leaving many women at continued risk.

“Despite initial declines, the institutional maternal mortality ratio has stagnated since 2018,” the study noted.

Garissa and Mombasa lead the list of highest-risk counties, each reporting maternal mortality above 200 per 100,000 live births, more than double the national rate. Kisumu, Isiolo, and Tana River also show elevated risk levels, ranging from 150 to 200.

Even Nairobi, Kenya’s capital, with numerous hospitals and specialists, recorded 132, underlining that urban centres are not automatically safer for mothers.

Stillbirths tell a similar story. Tana River reported the worst outcome, with 32 per 1,000 births, meaning almost one in every 30 babies was born dead.

In contrast, counties such as Nyamira, Elgeyo Marakwet, and Nandi posted maternal mortality below 50 and stillbirths as low as 11 per 1,000 births.

“The wide county variations suggest persistent inequities in access to and quality of maternal health services,” the researchers said.

The study shows that a woman’s survival chances in childbirth remain heavily influenced by geography. Counties with high maternal deaths often face shortages of skilled health workers, limited emergency care, and poorly equipped facilities, while better-resourced counties offer stronger services and more reliable reporting.

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“Counties with referral hospitals often report higher mortality due to concentration of complicated cases,” the study added, highlighting Nairobi as an example.

The research also exposed inconsistencies in reporting. While KHIS and MPDSR tracked similar trends, MPDSR consistently underreported deaths. In 2022, MPDSR recorded only 57 per cent of expected maternal deaths compared with KHIS, a gap that is most severe in counties with weaker health systems.

“Underreporting of maternal deaths and stillbirths is more likely in counties with weaker health systems, which are also the counties where women face the highest risks,” the authors warned.