Aspects of demography and maternal health care in reducing disaster mortality and morbidity in Kenya

Key definitions Demography is the study of both quantitative and qualitative aspects of human population (static and dynamic aspects). Static aspects: Age, Sex, Race, Marital status, Economic characteristics Dynamic aspects: Fertility, Mortality, Nuptiality, Migration, Growth Linked to disasters: Composition, density, distribution, growth, movement, size, and structure of the population. Mortality refers to the incidence of death or the number of deaths in a population Morbidity refers to the state of being diseased or unhealthy within a population

Introduction The increasing prevalence of disasters necessitates urgent need for understanding how major disruptive events affect various demographic processes Disasters significantly pose impact to mortality, fertility, health and disrupts migration patterns of populations and communities The extent of mortality caused by disasters varies depending on factors such as type of disaster, location, and timing. Understanding population dynamics and mobility is therefore one of the defining components of disaster preparedness and response. While these processes are intimately inter-related, there have been relatively few integrative analyses due to inadequate data (exclusion of demographers in disaster preparedness and planning). Investment in population data collection and collation systems will provide valuable framework in investments in advance understanding of demographic changes and linkages to disaster risk reduction and inform policy interventions

Link between disasters and demography The risk of death vary by age and sex, due to differences in vulnerability (physical differences or likelihood of exposure) – geographical differences? Demographic data can be used to identify vulnerable populations prior to a disaster Access to services before, during and after a disaster event is linked to basic demographic features, social and economic context and distribution of populations Disaggregated data enable policy-makers to identify vulnerable populations in the context of disaster preparedness (for timely response) Morbidity measures can indicate where “scarce health resources are already stretched by existing health priorities” and where a public health emergency is likely to have a greater impact (Hurricane Katrina) – Mandera cholera &Chikungunya

Global trends: disaster mortalities vs. maternal health Maternal mortality linked to state of maternal heath care Deaths: Haiti Earthquake: 67% of deaths children < 12 years Japan tsunami: deaths were lowest for children” Indian Ocean tsunami: majority deaths – children and old USA Hurricane Katrina: Majority 75 years or older Health problems triggered by a disaster can continue in the long- term. Morbidity after disaster extends beyond physical health – long-term

State of maternal health in Kenya (Kenya Demographic Health Survey, 2014) 6,632 maternal deaths in 2013 alone (18/day) - Kenya 2,136/3,795 maternal deaths – Mandera 175/ 1,594 maternal deaths - Turkana

Health and demographic trendsValues and % Fertility trends3.9 Contraception use (%)58% Demand for family planning76% neonatal mortality 22/1000 Maternal Health Antenantal Care58% Delivery Care58% Trends in Antenatal and Delivery Care96% Protection against Neonatal Tetanus76% Postnatal Care51% FGM (% of women circumsised)21% FISTULA (obstetric fistula)1% State of maternal health in Kenya (Kenya Demographic Health Survey, 2014)

Fertility vs contraception use (KDHS)

Leading cause % Pre-existing medical conditions exacerbated by pregnancy (such as diabetes, malaria, HIV, obesity) 28 Severe bleeding 27 Pregnancy induced high blood pressure 14 Infections (mostly after childbirth) 11 Obstructed labour and other direct causes 9 Abortion complications 8 Blood clots 3 Global estimates for causes of maternal mortality (WHO)

Global: 249 vs. Kenya: 510/100,000 (WHO, 2015) Kenya: 98% deaths in 15/47 Counties Maternal death: (6000-8,000)/yr 15 % of deaths.

Challenges and opportunities Mapping out maternal health care services linked to disaster risks (MoH, UNFPA) Limited access to Sexual reproductive health services: Only 10% of public health facilities in Kenya are youth friendly (SARAM, 2013) –Prepositioning SRH/dignity kits for early response –Mapping health skills and especially disaster prone zones (partnerships) –Capacity building for health service delivery and response to SGBV

Issues of maternal health in reducing disaster mortality and morbidity Scaling up healthcare and immunisations (ahead of predictable disaster events)healthcare Health and social-economic inequalities are associated with variety of factors leading to increase or reduction in disaster mortality/morbidity Several SDG indicators aim to capture the increased health risks specifically associated with reproduction for women –to address inequities in access to and quality of sexual, reproductive, maternal and new-born health information and services; –to ensure UHC for comprehensive sexual, reproductive, maternal and new- born health care; –to address all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities; –to strengthen health systems to respond to the needs and priorities of women and girls; and –to ensure accountability to improve quality of care and equity.

Policy implications for Disaster Risk Management in Kenya SDG Target 3. “Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks” 1.Increase the level and efficiency of investments to strengthen country health information system 2.Strengthen country capacity to collect, compile, share, disaggregate, analyse, disseminate, and use data at all levels of the health system: 3.Ensure well-functioning sources for generating population health data 4.Maximize effective use of the data revolution to improve health facility and community information systems empowering decision-makers at all levels with real-time access to information 5.Promote governance with citizen and community participation for accountability linked to the health-related SDGs:

Investments in better health, including reproductive health, are essential for individual security and for reducing disaster mortality and morbidityreproductive health Access to sexual and reproductive health, including family planning, can affect population dynamics through voluntary fertility reduction and reductions in infant and maternal mortality.family planning Investing in monitoring demographic and health requirements (public health) linked to other sectors (water and sanitation, nutrition, protection,) and factor into contingency planning. Demography is a central component of societal contexts and social change – inclusion of demographers in disaster risk management Policy implications for Disaster Risk Management in Kenya