Dr Beldina Gikundi’s daily prayer is that the handful of malnourished pregnant Somali women who go into labour at the Dadaab refugee complex do not develop complications that might require a caesarean section.
This is because Somali cultural beliefs regarding who can give consent, mean she and her staff at Hagadera Hospital are unlikely to be able to operate on the women in time to save their lives and those of their unborn children.
Among the Somali, only the expectant woman’s father in-law and in his absence, her husband, can give consent before the procedure is undertaken.
“We have lost several infants due to prolonged labour.
Each day between three and five women go into labour here,” said Dr Gikundi, who is in charge of the maternity unit at the hospital.
Hagadera Hospital is a fully-fledged health facility at the Dadaab refugee complex in northeastern Kenya.
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It is the biggest in the world and is divided into three — Ifo, Dagahaley and Hagadera camps, housing over 440,000 refugees, mostly Somali.
The hospital is run by the non-governmental organisation International Rescue Committee and has 120 beds. It provides free inpatient and outpatient services and has a 24-hour theatre for emergency surgery.
But despite this, the lives of Somali women remain at risk due to labour complications.
The majority of the refugees at Dadaab are women, as their husbands and menfolk either remained behind in their villages to protect their belongings, or were working in the Somali capital Mogadishu at the time the famine struck and their families were forced to flee the region in search of aid. And here is where the trouble lies.
Dr Gikundi recalls that, on many occasions, the hospital has had to either send someone to Mogadishu, or to the women’s villages in south Somalia, to search for their husbands or fathers-in-law to give them consent.
“As a result, we have seen women remain in labour for two or sometimes more days before we get the right people to give the consent for a life saving operation,” she said.
Apart from losing the unborn infants, said Dr Gikundi, the women run a high risk of developing vesicovaginal or obstetric fistula. Obstetric fistula is caused by extended pressure of the child’s head against the soft tissue in the mother’s pelvis during childbirth.
The tissue eventually dies from the lack of blood supply and a hole develops between either the rectum and vagina or between the bladder and vagina.
Women who suffer fistula are usually unable to control the flow of urine or faeces. They are often stigmatised by their communities and families because of their condition.
“We repair an average of three cases of vesicovaginal fistula every month, which is a very high rate,” said Dr Gikundi.
Ann Burton, a senior public health officer for UNHCR at Dadaab said: “Delay in seeking care for pregnancy-related complications and consent for life-saving procedures like caesarean sections, among other reasons, have hampered progress in reducing maternal mortality and morbidity among refugees in Dadaab.”
She said 14 women died during labour at Dadaab between January and July.“This is sad because no woman should die while bringing forth a new life,” Burton said.
Other obstacles to maternal health are the practice of female genital mutilation and the almost non-existent use of contraceptives.
According to public health experts at the UNHCR, almost all the Somalis at Dadaab practice FGM. Studies in many countries have linked FGM to the increased risk of maternal and child morbidity and mortality due to obstructed labour.
“Women who have undergone FGM are twice as likely to die during childbirth and are more likely to give birth to a stillborn child than other women,” explained Dr Joseph Karanja, a gynaecologist in Nairobi, Kenya.
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The infant nutritional expert at Hagadera Hospital, Hadija Mohammed, said that many Somalis believed using contraceptives would cause infertility and other health complications.
A July survey by UNHCR of the Ifo, Dagahaley and Hagadera camps found that contraceptive uptake among refugees was two per cent, three per cent and one per cent respectively.
As a result, the fertility rate at Dadaab is alarmingly high. On average women here have more than nine children in their lifetime.
However, UNCHR reports that there is a high attendance of antenatal care clinics. “Between January and July, 95 per cent of all pregnant women at Ifo and Hagadera camps attended antenatal clinics four times during their pregnancies, as recommended by the World Health Organisation,” said Burton.
Also, between 84 and 94 per cent of women at Dadaab gave birth under the supervision of a skilled birth attendant between January and July. Gikundi said the hospital also had a 24-hour ambulance service to transport pregnant mothers.
“We also have informants, who are equal to community health workers, who keep monitoring pregnant women, reminding them of the importance of attending antenatal clinics. They will also call for an ambulance in case of complications or labour pains,” said Gikundi.
IPS
More women in sub-Saharan Africa are using short term birth control methods compared with those using long term contraceptives.
or fear to use them for lack of guidance from experts in hospitals, according to a new study.
The study found that the extent to which family planning programmes reach all segments of the population is disappointingly low but varies between and within countries.
Researchers noted that the need for contraception is not being adequately addressed among all segments of society, and especially among the poor.
The sudy, conducted in Kenya, Uganda, Tanzania, Senegal, Mozambique, Namibia and Madagascar, was aimed at reviewing trends in the use of short-term and long-term methods of contraception in developing countries.
The long-term methods reviewed in the study included intrauterine devices (IUD), implants and sterilisation, while the short-term methods included pills, condoms, spermicides and injectables.
Reserachers noted that women of reproductive age were more likely to use birth control methods to space rather than to stop childbearing.
In all the countries included in the study, there was a substantial increase in the use of short-term methods.
The pill was found to be the most widely used method by women in their teens and 20s, women who are cohabiting, women with no children and women with at least a college degree.
Injectable hormones were also popular. About 12 million women between the ages of 15 and 49 in sub-Saharan Africa, roughly 6 per cent of all women in that age group, use them.
Many of these women while using the contraceptives complained of headaches, irregular/clotty and heavy menstrual periods, overweight, having struggled with fertility issues afterwards by either failing to conceive again or delayed conception.
The experience with the Intra – Uterine Device (IUD) was believed to have caused them urinary tract infections all the time while those on pills complained of spitting all the time.
Contraceptives are classified into hormonal and non hormonal types.
According to George Maha, a gynecologist at Marie Stopes clinic, the hormonal contraceptives like pills, injectables are the most likely methods associated with the above side effects.
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“For example, the progestin hormone birth-control shot, such as Depo-Provera given every three months causes weight gain, the common side effect experienced by most women because the progestin hormone causes water retention in their body which leading to overweight. This can lead to cardiovascular disorders and even mood changes”, said Dr Maha.
He explains that the long term/ non hormonal methods like the IUD can only cause infertility if one is promiscuous or has sexually transmitted diseases like HIV.
“IUD method are mostly suited for people who have few children because in this case their uterine wall is not stretched thus it is not possible for one to conceive while having it like the cases we encounter once in a while”, said Dr Maha.
“Women should therefore consult a specialist first and be assessed before using any contraceptive to be sure which method best suits them”.
Source: The East African
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