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When Amina Mohammed, nine months pregnant with her fifth child, began to bleed, she knew that something was wrong. First her relatives took her to the nearest clinic, but the doctor, lacking the facilities to deal with her, turned her away. When an ambulance arrived after an hour and a half to take her to hospital, her baby was dead and her life was in danger. She had suffered a massive uterine rupture, a tearing of the womb, and was rapidly bleeding to death.
She was in danger of becoming another statistic in a region where statistics really matter. Few people think of Mandera when they think of Kenya, a vibrant East African economic powerhouse boasting some of the best private healthcare in the region. The remote location and the widespread practise of child marriage and female genital mutilation FGM mean that the odds are stacked against women. Luckily for Ms Mohammed, she reached help just in time. She was unable to speak, her tongue swollen by a tumour.
She made no sound as the nurse explained how this pregnancy, coming so soon after the last one, weakened her uterus wall to the point of bursting. She survived only because her relatives accompanied her to the hospital, and donated the blood she needed to save her life. The hospital has no blood bank, and the nearest facility is hundreds of miles away in Garissa, too far to be of much use. But many women here live in the bush in far-flung parts of the county, and never see a single health worker throughout their pregnancy.
When it comes to giving birth, they turn to unskilled helpers to guide them through it. When something goes wrong, they might be hours away from help, forced to walk to the nearest clinic, which itself may be ill-equipped. Some of the worst complications come as a result of FGM. For a woman having her first child, it can extend labour by hours and cause tearing; sometimes women simply bleed to death.
With child marriage so widespread here, the problem is made worse, not least because their bodies are too immature for birth, but also because they have no say over their care. No scheduled air-carrier flies here, and President Uhuru Kenyatta, nearly three years into his first term, has yet to visit. When in the British handed the entire north-east, closest to Somalia in terms of ethnicity, language and culture, to Kenya at independence, it plunged the region into a four-year secessionist conflict, triggering decades of marginalisation.