A Kenyan mother bled for hours after childbirth and died as healthcare remains weak

KILIFI, Kenya (AP) — As Penina Zawadi was wheeled to the operating room for a cesarean section, she gave her mother her jewelry for safekeeping, along with a reassuring word: She would have a safe delivery.

An hour later, a nurse handed Esther Bendera her newborn grandson. But her daughter did not return. Her family said the 29-year-old Zawadi bled heavily after birth and was sent to another hospital to have her uterus removed, a last-ditch measure. She spent several days in intensive care before dying on June 23.

“She was bleeding so much, you would think it was water gushing out,” Bendera recalled. “After the second surgery, she never opened her eyes again.”

She said Zawadi, who had been healthy in pregnancy, spent four hours bleeding at Malindi Hospital awaiting a referral to the larger facility in coastal Kenya , Kilifi County Referral Hospital, an hour's drive on a potholed road.

This is part of a series on maternal mortality in sub-Saharan Africa , which has the world’s fastest-growing population and accounts for 70% of global maternal deaths. Around 180,000 pregnancy deaths are recorded every year across the continent.

The story of Zawadi, whose name means “gift” in Swahili, resonates with many families in Kenya’s largely rural Kilifi County, where maternal mortality rates are far higher than the national average. The deaths occur in the shadows of the area’s thriving tourism industry for foreigners and locals along the Indian Ocean’s white sands.

Kilifi County saw 532 mothers die for every 100,000 live births while the national average was 355 deaths, according to the latest government data in 2022. Most deaths are caused by severe bleeding, obstructed labor, high blood pressure-linked conditions such as preeclampsia, and infections due to unsafe abortions, according to reproductive rights organizations.

The deaths are also caused by shortages — of basic medical equipment in local clinics, of transport to better care, of information shared with pregnant women and their families.

In June, the Kilifi County government said it had recorded 81 deaths in the last year and a half, which it called progress. It pointed to recent changes such as increasing the number of healthcare facilities to bring services closer to mothers.

And yet some local clinics are still just outposts among the mud-walled homes, often stocked with little more than painkillers and antacid medications. Recent funding cuts by the Trump administration and other donors have deepened the challenges, especially for some of the poorest of Kenya's poor.

At a fundraiser held during Zawadi’s funeral to help offset expenses, most people could only contribute about a dollar each.

Her family said Zawadi had been generous and good-natured, eager to make jokes. After her coffin was lowered into the grave and coral stones were arranged on top, her firstborn son, aged 5, was led to it and wailed.

But the newborn son was considered a bad omen and could not attend the funeral. He had to undergo what the Giriama people of coastal Kenya consider to be cleansing rituals.

Zawadi's husband had been without a stable income and now must raise the boys with the community's assistance. Zawadi's father, Nixon Charo, a civil servant, described how already he had been sending food money to the young family.

Charo urged the government to ensure that hospitals are well-equipped to handle complications during childbirth, and to not leave frantic families waiting for information.

“We never got to know how serious the complications were,” Charo said.

Chadi Karisa is part of the effort to bring healthcare closer to pregnant women. He runs a community health center in Kilifi’s Gongoni area, where people previously had to travel 90 kilometers (56 miles) for basic care.

He said he has witnessed deaths around childbirth while helping with deliveries, and noted the communication gap with patients and families. Health workers can lack motivation due to being underpaid and overworked, he said, and some view inquisitive patients as a bother.

At the same time, some mothers fail to attend prenatal clinics where complications such as anemia and hypertension can be detected. In most cases, pregnant women "arrive very late because some of the mothers are still ignorant and lack information on maternal health,” he said.

A local nongovernmental organization, Youth Voices and Action Initiative, is trying to educate women and girls through community forums and a podcast.

“We really need to have these conversations with community gatekeepers, especially the community health promoters," said its CEO, Leila Abdulkheir. “These are the people that the women prefer to talk to and are trusted within the community.”

Halima Ramadhan died in March while delivering twins, a week past her due date, and her family says they still don't know what caused her death.

The staff at Malindi Hospital recommended a cesarean section. An hour later, they presented Ramadhan's mother-in-law, Mariam Kazungu, with the twins — a boy and a girl — and said their mother was in recovery.

Kazungu was then asked to buy medicine at a private pharmacy, with no explanation. During the three weeks that the 27-year-old Ramadhan was in intensive care, Kazungu said nurses kept asking her to buy more, still with no word of Ramadhan's condition.

“I never thought a big government hospital would lack medicine. I’d rather have taken her to a private hospital and even called for a fundraiser so she could receive better care,” Kazungu said.

Only after she showed The Associated Press the discharge summary for Ramadhan, which cited heart failure after high blood pressure, did her family finally learn her cause of death. Kazungu had not tried to read and understand it.

The Kilifi County government did not respond to questions about the deaths of Ramadhan and Zawadi or about the local maternal mortality rate.

Kazungu has quit her job as a chef to care for her new grandchildren. On a recent day, Ramadhan’s oldest child, not even 3, kissed the twins on the cheeks and recognized a photo of their mother.

The little girl believes she will be back, Kazungu said, and her eyes welled with tears.

“She never got to see her children,” she said.

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