1. A PRICE TOO HIGH TO BEAR: THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES Rebecca Njuki Senior Technical Advisor/Interim Country Manager Family Care International CONSULTATIVE MEETING ON ACCELERATING THE ATTAINMENT OF MDG 5 IN KENYA August 28 th, 2014

2. Overview of study Objective: To document financial and social costs of maternal death and how these costs affect families’ wellbeing Conducted in Rarieda, Gem and Siaya Sub-Counties Data collected from families where a mother died during pregnancy and childbirth and compared with families where the mother had a safe pregnancy and childbirth. A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

3. Key findings

4. Neonatal Survival Of the 59 maternal death cases, 31 infants survived delivery but – 8 died in the first week – Another 8 died in the next several weeks ONLY 15 surviving babies A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

5. Children’s Schooling Children dropped out of school because the household could not afford to pay fees due – Loss of the woman’s income – Household income went toward hiring casual labor Gave up homework time to take care of tasks their mother used to do A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

6. Financial Costs of Care Sought During Pregnancy We compared how much families paid for health care costs Costs were always higher for families that had a maternal death vs safe pregnancy and delivery – Average total cost of health care – Postpartum These high costs were especially hard for poor families A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

7. Funeral Costs Funeral costs were as high as 182,500; no household reported having insurance cover Majority of families received funding from household members, fundraising, welfare groups and sale of assets A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

8. The “Disruption Chain”: Ripple Effects of Maternal Death Economically active members of the household – Gave up or decreased time spent on income generating activities – Took days off: on average 16 days during illness and 26 days for funeral Agricultural activities and harvests diminished – Loss of labor of the deceased woman – Surviving adults now juggled farming work with additional household tasks Some households pushed further into poverty as they had to pay casual labor to work on their fields A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

9. Overall findings The loss of a mother harms her children’s health, education, and future opportunities The sudden loss of a productive woman disrupts the family’s economy and its daily life The cost of a fatal pregnancy and childbirth complications is a heavy economic burden Funeral costs are a crippling hardship for her family A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

10. Recommendations These findings catalyze renewed and strengthened efforts to: Ensure universal access to reproductive, maternal, newborn, and child health care Improve the quality of health services, including emergency obstetric care Strengthen referral services Improve financial and social support for women and families facing maternal health crises A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

11. Acknowledgements UK Government John D. & Catherine T. MacArthur Foundation The Partnership for Maternal and Child Health (PMNCH) Study participants Family Care International team International Center for Research on Women research team KEMRI/CDC HDSS team A P RICE T OO H IGH T O B EAR : THE COSTS OF MATERNAL MORTALITY TO FAMILIES AND COMMUNITIES

12. THANK YOU