A woman’s chance of surviving childbirth in Kenya still depends heavily on her home address.
This is revealed in a new analysis by the Ministry of Health and its partners, which ranks Garissa health facilities as among the deadliest places in Kenya to deliver a baby.
The report shows that while some counties have made childbirth relatively safe, others still expose mothers to shockingly high risks.
The officials set out to understand whether health facility records could reliably track maternal deaths and stillbirths across Kenya. “Maternal mortality and stillbirths remain a major public health concern globally and in Kenya,” the authors explained. “Population-based surveys are often costly and infrequent, so there is growing interest in using routine facility data to monitor progress.”
Led by statistician Rose Muthee at the Ministry of Health, the researchers examined records from 2011 to 2022 drawn from the Kenya Health Information System (KHIS) and the Maternal and Perinatal Death Surveillance and Response (MPDSR). The goal was to understand how many mothers die while giving birth in health facilities and how many babies are stillborn.
The final numbers show progress mixed with disappointment. Maternal deaths in facilities dropped from 132 per 100,000 live births in 2011 to 97 in 2022. Stillbirths also declined, from 24 per 1,000 births to 16 per 1,000 over the same period. Yet progress has stalled in recent years. “Despite initial declines, the institutional maternal mortality ratio has stagnated since 2018,” the study noted.
That stall means lives continue to be lost unnecessarily. Garissa and Mombasa top the list of danger zones, each recording maternal mortality ratios above 200 deaths per 100,000 live births, more than double the national average. Kisumu, Isiolo, and Tana River follow closely, with ratios between 150 and 200.
Nairobi, despite its concentration of doctors and hospitals, is far from safe. The capital recorded 132, making it one of the riskiest places to deliver in Kenya compared with many rural counties.
Stillbirths tell a similar story. Tana River had the worst outcome, with 32 stillbirths for every 1,000 births. That means nearly one in every 30 babies was born dead. Some rural counties stand out surprisingly as beacons of safety. Nyamira, Elgeyo Marakwet, and Nandi posted maternal mortality ratios below 50.
That is less than half the national average and a fraction of the death rates in counties like Garissa. Nyamira also led the way in stillbirth outcomes, with just 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 suggests a woman’s chance of surviving childbirth in Kenya still depends heavily on her home address. The reasons behind these stark inequalities are complex.
Counties with high maternal deaths often struggle with shortages of skilled health workers, weak emergency response systems, and poorly equipped hospitals. Wealthier or better-managed counties, by contrast, provide stronger services and more consistent reporting.
The study also suggests that counties with referral hospitals, such as Nairobi, appear to have higher mortality rates, partly because they handle more complicated cases referred from elsewhere. “Counties with referral hospitals often report higher mortality due to concentration of complicated cases,” the paper explained.
The researchers compared the two reporting systems (KHIS and MPDSR) to test reliability and found troubling inconsistencies. “Although both systems reported similar trends, MPDSR consistently captured fewer deaths than KHIS, raising concerns about underreporting,” they warned.
In 2022, only 57 per cent of expected maternal deaths were recorded in MPDSR compared with KHIS. This underreporting is most severe in counties with weak health systems, creating what the authors call a cruel paradox. “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,” they said.
Which means the places where women die most are also those where their deaths are least likely to be counted. Reducing maternal deaths and stillbirths is a key part of the Sustainable Development Goals. Kenya has committed to bringing its maternal mortality ratio down to fewer than 70 deaths per 100,000 live births by 2030.
But with the current stagnation, that target looks increasingly out of reach unless drastic improvements are made in struggling counties.
The co-authors of the study are Helen Kiarie, Hannah Kagiri, Edward Serem, Simon Muchemi, and Scolastica Wabwire from the Ministry of Health. Others include Martin Mutua of the African Population and Health Research Centre in Nairobi and Ties Boerma of the University of Manitoba in Canada.
Their paper, Trends in maternal mortality and stillbirths by county in health facility data, Kenya, 2011-2022, was published in the BMC Pregnancy and Childbirth journal last week.
