The Demographic and Health Survey (DHS) is the holy grail that guides policymakers, researchers, and donors in determining and designing health priority interventions in Kenya

But the latest DHS, released two years ago, contains a seemingly innocuous but very significant omission: maternal mortality data. This has stripped policymakers and health workers of a statistic that has long guided decisions on how to save mothers’ lives. Every five years, the report provides answers to Kenya’s biggest health and nutrition problems, offering crucial insight into the resources required to address them. But this time, the survey’s most closely watched figure — the maternal mortality ratio — was conspicuously missing.

Since the first DHS was published in 1989, policymakers have tracked maternal health relentlessly. In 1998, Kenya began formally including maternal mortality in the report as an "important indicator for women's and reproductive health programmes in the country", according to the survey. The data was collected again in 2003, 2008, and 2014. Strangely, in 2022, the government released a survey filled with maternal health indicators—from antenatal care to place of delivery—but left out mortality.

“It is an indicator of the safety of motherhood but also the health of women of reproductive age,” said economist Kwame Owino, who also heads the think tank Institute of Economic Affairs in Kenya.

Conflicting Numbers, Confused Policymakers

The omission has left Kenya with numbers that lack consensus or corroboration. All the United Nations agencies, including UNICEF, the World Health Organization (WHO), and the UN Population Fund (UNFPA), cite 379 deaths per 100,000 live births as of 2023. The World Bank lists two figures: 179 deaths per 100,000 on its main portal and 149 in its gender documents. The Ministry of Health has, at different times, quoted USAID’s now-defunct estimate of 594, while in other instances citing census data that put it at 355.

These conflicting data have sown confusion within the Ministry of Health and the donor community. To resolve this, the Kenya National Bureau of Statistics has been instructed to conduct a dedicated survey to establish the country’s accurate maternal mortality ratio.

The decision was conveyed on 10 June 2025 at a Nairobi hotel where more than ten reproductive health organisations, county officials, and ministry staff from the Division of Family Health had assembled. According to notes from the session, which Defrontera obtained, participants voiced concern that Kenya’s ratio remained stubbornly high even as neighbouring countries had reduced theirs to below 200 deaths per 100,000.

When Defrontera sought clarity from KNBS on when the study would begin, the agency instead provided brand-new copies of the DHS 2022, the same one that omitted maternal mortality indicators. The agency did not directly respond to the grave omission in the 2022 report.

Data Systems in Jeopardy

The confusion comes at a precarious moment. Health experts warn that with DHS surveys stalled following a US government stop-work order, both counties and the national government risk allocating health resources blindly. Since its inception 41 years ago, the DHS has conducted more than 400 surveys in over 90 low- and middle-income countries, providing national data on maternal and child health and on diseases such as malaria, HIV, and TB. In Kenya alone, DHS has produced seven national surveys, malaria indicator surveys, and hundreds of specialised health studies.

For years, USAID funded the DHS, equipping it with resources to train enumerators who moved door to door with standardised questionnaires used globally. Once collected, the data was shipped to a US-based contractor, ICF International, which analysed and compiled the final reports. These surveys became the international “report card” on public health, guiding donors and governments on where children and women were dying, where malaria outbreaks were spreading, and where targeted responses were most needed.

In 2013, when maternal mortality stood at a shocking 488 deaths per 100,000 live births, then President Uhuru Kenyatta declared free maternity services in all public hospitals. That policy decision was directly informed by the DHS, civil registry data, and records from the Kenya Health Information System, which showed that more than a third of women still gave birth at home, far from skilled care, due to lack of money and distance to facilities.

A Fragile Future

Earlier this year, the US government confirmed it had terminated DHS funding altogether. A senior NGO director told Defrontera that the absence of unified data and the end of DHS made it “impossible for the country to allocate resources equitably”. In their words: “Now the loudest counties are the ones who will get the most money, where donors will be directed.”

The fragility of Kenya’s health data systems was further exposed when, immediately after the Trump administration’s executive order, the Kenya Health Information System — the country’s digital backbone for health data — went offline.

Officials later explained that the outage was due to unpaid software licences. “We had not paid for the licences; we have since paid them,” said Dr Issak Bashir, head of the Directorate of Family Health. The KHIS has since resumed operations, but the episode underscored how vulnerable Kenya’s data infrastructure remains without reliable funding.

Source: https://defrontera.org