Scars, blood and silence: The human cost of childbirth in Kenya’s forgotten regions

Blood trickled down her legs as she staggered into the cold, unforgiving night—her body weak and trembling, her life hanging by a thread.

With only a handful of cotton wool pressed between her thighs, every step sent waves of pain ripping through her. Yet Monicah Nyambura kept moving — not from strength, but from necessity.

Her baby had been born. But she was the one slipping away.

Three years later, that night still haunts her — a memory soaked in blood and silence, lingering like a wound that never healed.

She was just 25. A first-time mother. Hopeful, yet afraid — not only of childbirth but of something deeper. Something was carved into her childhood. Something cut into her.

Living in Kambi Sheikh Burat, Isiolo County, Nyambura had heard the whispers: women who had undergone female genital mutilation (FGM) often struggled in childbirth. They bled. They tore. Some never survived.

Forced cut

She had always feared it. But fear meant nothing when the cut was forced on her. Still a girl — too small to resist, too powerless to refuse. The blade took what it wanted and left behind a scar.

That scar returned to life the night she went into labour.

There was no hospital nearby. No functioning clinic. No ambulance. In her world, emergency care was a privilege reserved for others — not for women like her.

She delivered at home, like most women in her village, with the help of a traditional birth attendant. At first, everything seemed fine. But as the baby crowned, the scar tissue tore apart.

Blood began to flow. At first, they thought it was normal. Childbirth is messy, after all. But this wasn’t a mess — it was danger.

An hour passed. The bleeding continued, soaking through cloth after cloth. Her hands were cold. Her lips pale. Her body was failing her.

Fear

"I was dizzy. I couldn't feel my legs," Nyambura remembers. "They told me to stay calm... but I could see the fear in their eyes."

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• Health
• FGM
• childbirth
• traditional birth attendants
• maternal health care
• Kenya’s forgotten regions
• Scars
• blood and silence: The human cost of childbirth in Kenya’s forgotten regions

Panic set in, but help felt like a cruel joke.

A taxi to the hospital cost about Sh1,000 — money they didn’t have. Motorbike riders, their only hope, refused to come. It was a deep night, and insecurity plagued the area. No one wanted to risk their life, not even for a dying woman.

So Nyambura did the unthinkable.

She got up, still bleeding, and walked.

"I was holding myself... trying to stop the blood. I could barely see. My baby had already been born, but I felt like I was the one dying," she says.

A relative carried the newborn — tiny, fragile, crying into the night. Nyambura stumbled beside them, her body screaming with every step, her feet dragging through dust and darkness. The road stretched endlessly — quiet, cruel, indifferent.

They walked many kilometres in silence, her blood trailing behind and soaking into the dry earth.

"I kept thinking, 'What if I fall? What if I never get up again?' But there was no time for fear. I had to survive for my child."

Motorbike ride

At last, after what felt like a lifetime, they found a motorbike rider brave enough to take them to Isiolo General Hospital, still many kilometres away.

When she arrived, she collapsed.

"I don't remember much. Just pain... and cold... and hands lifting me onto a bed. They gave me blood — three bottles. They stitched me up. I was told I was lucky. That most women in my condition don't make it."

Now 28, she lives, breathes, and raises her children. But she has never forgotten that night.

Most women in her community never get that chance.

The only local clinic has been closed for over a decade. Ambulances? They’ve never seen one. Giving birth at home isn’t a choice — it’s a sentence.

Traditional birth attendant

At 60 years old, Hadija Bithu knows that truth well. A traditional birth attendant (TBA) in Burat Ward, Isiolo County, she has helped deliver more than 50 babies — her only training, the lessons learned from her mother.

In a region woven with different cultures, Hadija has assisted Borana, Turkana, Somali, Meru, and Samburu women — each bringing their own traditions, fears, and scars.

"I've seen so many things in my years. I've seen joy... and I've seen fear. Sometimes, I've seen death."

One memory clings to her: a mother who bled to death in her hands.

"She bled too much. I tried everything. But I couldn't save her."

Since that day, fear has shadowed her work.

"It's not like it used to be," Hadija says. "Now, the women bleed a lot. Too much. And it scares me."

Still, women keep coming.

Desperate. Frightened. Arriving at her door in the middle of the night, with no money, no transport, no options. And Hadija cannot turn them away.

"Some come sewn," she says softly, describing women who have undergone FGM. "And when they push... instead of water, blood gushes out. It terrifies me."

She has seen women cut, burned, and even sewn with thorns. Each case is different, but all carry pain.

Thick scars

"Sometimes the scars are so thick... even the razor cannot cut through," she says. "I try to make space for the baby to come out, but the woman starts bleeding heavily. You don't even know what you're cutting. You're just trying to make a way."

Through community health programmes, Hadija now refers complicated cases to hospitals. She knows when the risk is too high. She no longer relies only on surgical spirit and cloth — she keeps her phone ready to call for help.

"I don't allow death," she says. "If it's beyond me, I call for help. I've seen too much."

But even with this knowledge, women still choose her over hospitals.

"The hospitals ask for too much money. The women say they go to clinics during pregnancy, but when labour starts, they run to us."

Childbirth at home

Catherine Juma, 48, also a TBA in Burat Ward, has delivered countless babies and experienced childbirth at home herself. Today, she opens her door to expectant mothers, just as others once did for her.

"Women come because they have no one else. The hospital is far. We help because it's what we've always done," she says.

Isiolo General Hospital — the only reliable facility — lies many kilometres away. For women in labour, especially at night, reaching it is often impossible. No ambulances. No clinics. No quick help.

So, they come to Catherine.

"Long ago, we didn't have these many problems," she recalls. "But things have changed. Now, women bleed a lot. I've seen so much blood... and now, I think my eyes are going bad. I'm afraid."

Her voice falters when she remembers the worst.

"There was a woman... she couldn't push. The baby came badly — she pulled on the ground, on the dirt... The baby later died. Since then, I've been afraid."

Still, she continues. Because even in fear, she cannot turn women away.

"We need help," she says firmly. "This distance to the hospital is too much. There's no water. Sometimes, men disturb us when we go to fetch it. It's not safe."

She remembers one night vividly.

"A woman came to deliver. I only had one mtungi (jerrycan) of water. That's all. I had to go to the laga (dry riverbed) at night to fetch more. I was scared — I thought I would be beaten. But I went. I washed her. She delivered safely. Now her child is eight months old."

Wounds that never heal

That night was a small victory. But Catherine also carries wounds that never heal.

"The baby came facing the legs. The bleeding wouldn't stop. The birth attendant helping her was afraid... and ran. Left her there. My sister died."

She pauses.

"That's the kind of fear we live with. Women bleed so much in Kambi Sheikh. Some die. I've never lost a woman myself, but it's scary. Very scary."

Even referrals come with challenges: no transport, no supplies, no trained staff.

Sophy, a community health promoter in Isiolo, confirms the crisis. Many women cannot even afford the 700 shillings needed for hospital registration. Recently, she says, three women died.

"We have buried three women. Many give birth prematurely and suffer heavy bleeding. Sometimes we have to rush to find blood donors, causing dangerous delays, and some women don't receive blood in time."

A health facility once stood in Akadeli — but it has been closed for 15 years.

"If the hospital were operational again, it would provide timely care and reduce the long distances women currently travel. It would save many lives."

The absence of nearby facilities continues to cost lives. Restoring Akadeli would bring maternal health care closer, preventing unnecessary deaths.

Systemic challenges

Dr Simon Kigondu, obstetrician-gynaecologist and President of the Kenya Medical Association, says the challenges are systemic, particularly in arid and semi-arid lands (ASALs). Postpartum haemorrhage (PPH), he explains, remains one of the leading causes of maternal death.

According to him, three key delays drive poor outcomes: delays in decision-making, delays in accessing facilities, and delays in receiving care on arrival.

"In many ASAL communities, cultural norms dictate that women must seek consent—often from their husbands—before going to a health facility," he explains. "Sometimes the husband controls the finances, causing critical delays in deciding to seek help."

Poor infrastructure adds to the risk. Some communities in Isiolo live as far as 170 kilometres from the referral hospital.

"The region is vast, the roads are poor, and access to vehicles is limited. Ambulance services are either unavailable or too far to be of timely help," Dr Kigondu notes.

Sub-county hospitals exist, like Garbatulla, but chronic underfunding and lack of specialists undermine their effectiveness.

"Sometimes the facilities lack even the most basic equipment or essential medications. In the past, some drugs degraded due to heat, but that is slowly changing with the introduction of heat-stable carbetocin—a life-saving drug that remains effective even in high temperatures."

Blood supply remains another national challenge.

"We try to mobilise blood donations, but the supply is still far from sufficient," he adds.

Early diagnosis

Early diagnosis and antenatal care are also critical, he stresses, to identify complications like placenta previa or placental abruption — but poor access to scans and skilled care means many go unnoticed.

Cultural beliefs also discourage Caesarean sections.

"In many of these communities, C-sections are seen as a sign of weakness. As a result, many women choose to deliver at home, attended by traditional birth attendants who often lack the skills to manage complications like postpartum haemorrhage."

He outlines the leading causes of PPH — the "Four Ts":

• Tone (uterine atony, when the uterus fails to contract),

• Trauma (tears or lacerations),

• Tissue (retained placenta), and

• Thrombin (clotting disorders).

"While female genital mutilation (FGM) may not obstruct labour, it often causes trauma and tearing, which can lead to excessive bleeding. Traditional birth attendants are rarely equipped to manage such emergencies."

Uterine atony

He adds that about 70per cent of PPH cases are due to uterine atony. Many deaths go unreported, especially those that happen at home.

"We don't always capture the full data, because many deaths occur at home and are never officially recorded."

Dr Kigondu says Kenya must embrace the Maternal and Perinatal Death Surveillance and Response (MPDSR) system to improve outcomes.

"Strengthening MPDSR, alongside improving antenatal care, emergency obstetric services, and community education, will significantly reduce maternal deaths," he says.

Kenya loses an estimated 10 women every day to postpartum haemorrhage. Experts warn the true figure could be higher, due to widespread underreporting.

In 2022, the MPDSR system captured only 57per cent of expected maternal deaths compared to the Kenya Health Information System (KHIS). The gap is worse in underserved counties with fragile health systems.

Garissa and Mombasa recorded the highest maternal mortality rates — over 200 deaths per 100,000 live births, more than double the national average. Kisumu, Isiolo, and Tana River also reported elevated rates, ranging from 150 to 200 deaths per 100,000 live births.