Midwives at the forefront of the fight against climate change: the case of Ijara County Hospital, Garissa

Midwives, with their unique combination of courage and indispensability, play a crucial role in the face of climate change. They provide culturally sensitive health care, serve as leaders in their communities, and act as emergency responders in times of crisis. When disasters such as weather events or conflict occur, midwives are often the first to respond to pregnant women, making them the most effective way to prevent maternal deaths.

The effects of climate change are not only a distant threat but a real and urgent threat to human health. In addition to directly causing disease and death, climate change also indirectly impacts health by reducing the outcomes of other social determinants of health (WHO framework). Climate-related health risks have a disproportionate impact on vulnerable and disadvantaged populations who often reside in areas with inadequate health infrastructure, making it difficult for them to cope.

The climate crisis carries specific threats for women and girls. Research shows that higher temperatures can lead to pregnancy complications and cause or worsen maternal health problems, including premature births and miscarriages.

As we mark this year’s International Day of the Midwife on May 5^thunder the overall theme of Midwives: a vital climate solutionThe Kenya Midwives Association is bringing together midwives from across the country under the theme “Sustainable Midwifery Care: Midwives at the Center of Green Beginnings.”

Kenya is among the countries most at risk from climate change, and women and girls remain vulnerable to preventable maternal deaths, child marriage and gender-based violence.

Garissa County, located in the Arid and Semi-Arid Lands (ASAL) region of northeastern Kenya and bordered to the east by Somalia, is no stranger to the effects of climate change. It is prone to droughts, floods and high temperatures, significantly affecting productivity, income and food security. With the increasing severity of these weather events, the challenges facing the county are only expected to increase. With a population of over 480,000 (2019), Garissa County has only 328 midwives (Source – Garissa County Health Department). Furthermore, the county has a maternal mortality rate (MMR) of 641 per 100,000 live births (KNBS 2019), almost double the national average of 355/100,000 live births, underscoring the urgent need for sustainable measures. “The county also faces other challenges regarding nurse-midwives, including inadequate capacity development, staff attrition, inadequate SMN infrastructure and equipment in health facilities; uptake of midwifery specialization is also very low,” reported Fatuma Ibrahim, Garissa County Reproductive Health Coordinator.

In this context, the Liverpool School of Tropical Medicine (LSTM), in collaboration with the Ministry of Health (MoH) of Kenya, has been implementing a Maternal and Newborn Health (MNH) program in Garissa County. Funded by the Takeda CSR program through the Global Fund, the program aims to contribute to reducing maternal and perinatal deaths in Garissa (and Kenya) through capacity building of frontline healthcare providers, who are predominantly nurse-midwives in Emergency Obstetrics and Neonatal Care, Integrated. Antenatal and postnatal care, and Quality of Care (QoC). Additionally, 20 health centers in Garissa received essential basic equipment to facilitate quality care for mothers and babies.

However, these health systems strengthening efforts are being undermined by the effects of climate change, including flooding, which disrupts transportation systems and prevents mothers and babies from accessing the life-saving care they need. .

“I accompanied a postpartum mother to the Garissa County Referral Hospital, located 200 kilometers from my station. Mother of two had developed breast complications 5 days after discharge from hospital following normal delivery of bouncing baby girl.” Matthew Ongoro, a midwife at Ijara Sub-County Hospital in Garissa County, narrates his first-hand experience when the county ambulance (see image below) he was traveling in was stranded for hours due to flooding that had caused the seasonal roads became impassable (see photo above).

In his eleven years of experience working in Garissa, Matthew Ongoro has seen these flooding scenarios become more frequent, an incidence he attributes to the negative effects of climate change on the environment.

“In addition to affecting the efficiency of referring patients between hospitals, flooding has often left roads impassable and communities have been completely cut off from the hospital for long periods, even months. In the case of obstetric emergencies, mothers are unable to access healthcare, which can lead to fatal outcomes for mothers, babies or even increased maternal and perinatal mortality,” adds Matthew Ongoro.

Mitigate the effects of climate change

Planting trees is one of the simplest and most effective ways to address climate change. Garissa County Government is aware of climate risks. She has led several initiatives in the county to mitigate the impact of climate change on people’s livelihoods (including midwives). In November 2023, Kenya celebrated a holiday dedicated to tree planting across the country. Garissa County, led by the County Commander’s Office, participated in a widespread tree planting exercise, an initiative of the Presidential Program for Accelerated Restoration of Forests and Grasslands Plant 15 billion trees in Kenya by 2032.

“Yes, Ijara Sub County Hospital staff actively participated in the tree planting activity. From the Office of the Deputy County Commander (DCC), we planted over 100 trees in just one day, including at the hospital and nursing homes,” recalls midwife Matthew Ongoro, who also won the EmONC Best Mentor of 2023 award. . in Garissa County.

Investment in midwifery staff has been shown to produce significant benefits in terms of improved health and social outcomes. For example, a recent study concluded that universal coverage of midwifery interventions would reduce mortality rates by two-thirds. This translates to 1.2 million lives saved annually by 2035 in the ESA region.

Midwives are the primary health care providers for mothers and newborns, and are instrumental in preventing a significant proportion of maternal and perinatal deaths (Lancet Global Health 2020). They are social role models and influencers who can advocate for a safer and more sustainable environment; Therefore, midwives are a vital climate solution.

As we commemorate the 2024 International Day of the Midwife, LSTM Kenya honors and appreciates midwives in Kenya and around the world and calls on the government and all stakeholders to urgently invest in creating an environment that enables midwives to perform their important work establishing pathways for quality education, providing the necessary resources and enabling them to act as full partners in all health systems around the world.

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