By Athuman Luchi.
Mombasa, the second largest city in Kenya, has high levels of drug abuse among its population, with drug addicts often overlooked and ostracized by society, leaving them forgotten by many authorities and healthcare facilities. This includes pregnant women, putting a large number of expectant mothers and newborns at risk, warn health experts.
Due to its coastal location, Mombasa is known to be a major drug trafficking route for countries across the world. Investigations have found heroin and cocaine from Asia and Latin America to transit through the port of Mombasa before getting into the rest of East Africa, as well as Europe and Dubai.
The scale of trafficking means a range of highly addictive drugs are readily available throughout the city, where many have started using and become addicted, causing them to now living on the street, particularly women.
A study conducted between September 1, 2022, and December 1, 2022, by the National Authority for the Campaign against Alcohol and Drug Abuse (NACADA) shows that 57.3% of women use drugs compared to 42.7% of men. The research shows that 45.6% of female drug addicts live in rural areas, while 54.4% live in Urban.54.9% of the female addicts are married, 8.7% are divorced, and 5.5% are widows.
The outcomes are particularly concerning for pregnant women, who have a lack of knowledge about and access to prenatal care services. These services are needed to ensure mother and baby stay healthy, according to The ReachOut Centre Trust, a Social support group in the community, led by Taib Abdulrahman.
Abdulrahman says that very few women with drug addictions visit health facilities, meaning that if they become pregnant; they fail to use antenatal care services. He added that hundreds of children die each year in Kenya during childbirth after their mothers fail to visit health care facilities when pregnant.
Dr. Daniel Wanyama, also with the ReachOut Centre Trust, explained that the use of drugs and alcohol during pregnancy can cause a range of complications such as premature birth, low birth weight, and development issues.
‘My mind was always preoccupied with where to get drugs’
In 2019, Salma Ismail, 30, began using Cocaine and Heroin when her mother passed away. “I didn’t have anyone to take care of me. My Mother’s death led me to be introduced to drug use, which made me start using them to relieve my stress” Salma said.
She developed an addiction which lasted three years. During this time, she lost three children during or soon after birth. Two of her babies died immediately after birth following breathing difficulties, and the third was born premature, according to Salma.
Salma says she never found the time to visit healthcare facilities during her pregnancies for prenatal care and went into labour on the street, giving birth without the care of any health professionals.
“I never once thought about going to a health facility because my mind was always preoccupied with where to get drugs,” Salma said. Since she began receiving help to overcome her drug addiction, she constantly thinks about the children she lost.
“I deeply regret it. I didn’t understand the importance of prenatal care, so I gave birth on the streets,” Salma said.
Avoiding abuse and stigma
But Dr. Wanyama explained that these women face extensive social stigma and judgment, which can deter them from seeking help and further impact their pregnancies. “The fear of being labeled as a bad mother prevents them from accessing prenatal care and addiction treatment,” he said, adding that abuse or stigma from health workers further contributes to them avoiding healthcare settings.
Drug addicts often avoid healthcare facilities for fear of being shunned and mistreated by healthcare workers and the community, explains Pauline Mtinda, 35, who says society wrongly assumes that drug addicts are thieves.
“Most of us avoid healthcare facilities because we face discrimination and exclusion from society. They often think we’re there to steal,” Pauline explained.
She advises healthcare workers and people in general not to ridicule pregnant drug addicts when they seek healthcare and emphasized the urgent need for tailored support to prevent more mothers losing their babies or their own lives. “Healthcare providers and the community should embrace and assist pregnant drug addicts when they come to healthcare facilities,” Pauline emphasized.
Pauline battled drug addiction for ten years. In 2018 she sought help for her methadone addiction, and at the same time discovered she was four months pregnant and HIV positive.
“Drug addiction prevented me from realizing I was pregnant, but when a nurse confirmed my pregnancy, I was immediately referred to a nearby hospital for prenatal clinics, and I’m grateful I delivered safely, and my child is healthy, despite facing stigma from some healthcare workers and the public,” said Pauline.
Her care included regular checkups, medical assessments, and education and counseling for her pregnancy and her addiction, the clinic also provided HIV medication and monitoring for complications, ultrasound scans, birth attendants at labor and birth planning. She believes prenatal care helped her to have a healthy pregnancy and safe birth. “I followed the advice of healthcare workers and delivered my child safely,” Pauline said.
Managing Pregnancy, HIV and Addiction
According to the US Centres for Disease control (CDC), Drug addicts are at greater risk of getting HIV, due to the risk of sharing needles, syringes or other injecting materials that may be contaminated with HIV. According to 2022 Kenya Demographic health survey, an estimated 6% of people who inject drugs are HIV positive in Mombasa.
There are many risks posed to both mother and baby if the mother has HIV. Pregnancy can weaken the immune system, potentially accelerating the progression of HIV in the mother and babies are at increased risk of mortality if the virus is not stopped from passing on to them using antiretroviral during pregnancy and childbirth, according to Wanyama.
To reduce rates of HIV, the ReachOut Centre Trust educates addicts in Mombasa on the dangers of sharing needles. “We always ensure that they don’t share needles, we provide them with clean needles, and we encourage them to keep off from drug use by giving them Methadone (as a substitute) and counseling”, added Wanyama.
Dr. Wanyama believes specialized clinics and rehabilitation centers can help address the issue by catering to the specific needs of pregnant drug addicts. But there are just two of these facilities in Mombasa, and the majority of addicts are not aware of the ones that do exist.
Instead, social support groups in the community are making strides to bridge these gaps in care. The ReachOut Centre Trust is located close to where most of the drug addict’s sleep, offering a safe space for all drug addicts to share their experiences and receive health care at the same time. Judgment has no place here, Taib affirms.
Taib says his center offers prenatal and postnatal care guidance. “We make a concerted effort to monitor the prenatal care of these addicts until they give birth safely. We also provide them with antenatal care, and birth attendants for labour,” Taib said.
He mentions that since starting the Prenatal and Post Natal care program for drug addicts three years ago, they have assisted approximately 50 addicts through prenatal care and delivery, with all of them giving birth to healthy children.
In July, Mombasa county governor Abdulswamad Shariff Nassir launched the Mombasa Care health program which is stated to provide a comprehensive National Health Insurance Fund (NHIF) to help 15, 000 vulnerable families in the county, including pregnant women with drug addictions. The program is stated to cover all common diseases, prenatal care and other specialties across all the government facilities.
Nassir said his government is working to create awareness campaigns to encourage all residents to seek and use these health care services. He also emphasized the need for healthcare workers to visit the places where vulnerable groups reside to identify pregnant individuals and include them in prenatal care programs and other health services.
Taib lauded the Mombasa Care program, saying it will make a big difference to the care of these women on the streets, and both reduce mortality and improve health equity. “Timely access to healthcare can save lives by addressing medical emergencies and chronic conditions effectively, also it can address disparities in healthcare access and outcomes among different population, promoting fairness and equality,” said Taib.
