The World Health Organization estimates that a pregnant woman from a developing country is 36 times more likely to suffer from pregnancy complications compared with a pregnant woman from a developed country. These complications easily lead to death.

According to the WHO, the leading causes of death in developing countries are severe bleeding, hypertension, sepsis, unsafe abortion, and obstructed labour. “One-third of all pregnancy-related complications can be treated with surgery. These include severe bleeding, unsafe abortion, obstructed labor, and obstetric fistula,” cites the WHO.

Severe bleeding

A pregnant woman will be diagnosed as having severe bleeding if she suffers any blood loss of more than 500mL within 24 hours after giving birth. There are various causes of severe bleeding in the few hours after delivery.

According to the WHO, severe bleeding after child birth results from failure of the uterus to contract, genital tract trauma, rupture of the uterus, retained placental tissue, or maternal bleeding disorders.

Unsafe abortion

Unsafe abortion refers to the termination of an unwanted pregnancy without medical authorization, without proper medical oversight, and the activity of termination of such an unwanted pregnancy by an individual who is not medically qualified or in an environment that lacks the necessary medical standards and equipment for a proper procedure.

The WHO estimates that every year, 42 million pregnancies are voluntarily terminated across the world. 22 million of these pregnancies are terminated within the law, while 20 million are terminated outside of the law. This implies that as many as these pregnancies could be classified as unsafe with the potential to kill the pregnant women who seek after termination.

“The 20 million abortions are performed by unskilled attendants or in unhygienic conditions. Only one in three abortions in developing countries occurs in safe conditions while 98 per cent are unsafe. One in four of unsafe abortions will likely result in severe complications, even death,” states the WHO.

The WHO estimates that every year, 68,000 women die from unsafe abortions and between two to seven million women suffer from long-term damage of reproductive organs or disease across the world.

In Kenya, the report ‘The Costs of Treating Unsafe Abortion Complications in Public Health Facilities in Kenya’ from the African Population and Health Research Centre (APHRC) and the Ministry of Health shows that at least seven women die from complications related to unsafe abortions every day.

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In addition to this, according to the 2014 Kenya Demographic Health Survey (KDHS), unsafe abortions in Kenya accounted for 35 per cent of all maternal deaths. A good size of women who seek abortion are married. For instance, the KNH study titled ‘Acceptability of Rapid HIV Test Screening Among Patients Presenting with Incomplete Abortion at Kenyatta National Hospital’, further noted that nearly two thirds of women who seek post abortion care services were married, 22 per cent were single, 12 per cent were divorced or separated while 4.4 per cent were widowed.

A related study that was conducted by Marie Stopes and published in the journal Plos One in November last year showed that 22.4 per cent of women living in Nairobi who procured abortions were married, partnered or cohabiting. This study also involved The University of California, San Francisco (UCSF), and Innovations for Poverty Action (IPA).

Obstructed labour

This type of complication occurs when the passage of the fetus through the pelvis is impeded. The WHO lists the most common causes as being a large fetal head passing through a small pelvis, wrong position of the fetus while going through the birth canal, and fetal defects.

“Obstructed labor is a major cause of maternal mortality, accounting for 1–5 deaths per 1,000 live births,” cites the WHO. “It is more common in developing countries due to lack of adequate health care delivery facilities, poor nutrition resulting in small pelves, poverty, and socioeconomic and cultural factors that are against traditional antenatal care and delivery.”

With this type of complication, it is highly likely that an outcome of fetal death may be recorded.  “Obstructed labor requires emergency cesarean section. If this doesn’t happen, the mother is likely to lose the baby and developing an obstetric fistula,” the WHO cautions.

Obstetric fistula

Obstetric fistula is a health condition in which the patient has a hole between the birth canal and bladder or rectum. This hole is usually caused by prolonged and obstructed labour. Women who have this condition are diagnosed as having incontinence for urine and, or stool.

“This means that the patient might experience vesicovaginal fistula which is interpreted as urinary incontinence or leakage of urine into the vagina. The patient may also have rectovaginal fistula in which they have fecal incontinence or leakage of rectal excrete into the vagina,” says Obstetrician-Gynecologist Janet Thuthwa.

What many women with this condition don’t know is that obstetric fistulas can be treated with surgical reconstruction. “This type of treatment has a 90 percent rate of success the majority of uncomplicated cases and 60 per cent rate of success for the very complicated cases,” the WHO says.