Every day in Kenya, an estimated 16 women die from pregnancy-related causes. That is roughly one mother lost every 90 minutes and largely to preventable circumstances: the absence of a skilled nurse, a facility too far to reach, a postnatal check that never happened, according to the World Health Organisation’s (WHO) Partnership for Maternal, Newborn and Child Health. 

Kenya’s maternal mortality ratio has been declining, from 183 deaths per 100,000 live births in 2021 to an estimated 149 in 2023. But WHO’s Sustainable Development Goal benchmark is fewer than 70 deaths per 100,000 by 2030. With less than five years remaining, the pace is not enough. 

The gains Kenya has made are real. They are also profoundly uneven. 

Across four critical indicators – immunisations, births attended by skilled providers, antenatal visits, and postnatal checks – the county-level data tells a stark story. Between Kirinyaga, which records immunisation rates above 80 per cent, and Garissa, which sits below 20 per cent, lies a roughly fivefold difference. 

Garissa sits at or near the bottom across all four indicators simultaneously, making it arguably the single most at-risk county in Kenya’s maternal health dataset. It is joined at the lower end by Mandera, Wajir, Turkana, Samburu, and West Pokot – predominantly arid counties in northern and north-western Kenya, with sparse road networks, few health facilities, and a critical shortage of skilled health workers. 

At the other end, Kirinyaga, Taita-Taveta, and Meru consistently rank at or near the top, benefiting from stronger healthcare infrastructure, higher rates of maternal education, and better proximity to functional facilities. 

Urban women access skilled birth attendance at 82 per cent, compared to 50 per cent for rural women 

Immunisation coverage shows some of the clearest disparities. Nationally, 75 per cent of women received sufficient tetanus toxoid injections to protect their newborns, and 90 per cent took iron supplementation during pregnancy. But these averages conceal how unevenly those gains are spread, leaving infants in Garissa, West Pokot, and Wajir exposed to preventable diseases, including measles and polio. 

The wealth and geography gaps are equally sharp. UNICEF figures show that urban women access skilled birth attendance at 82 per cent, compared to 50 per cent for rural women. Amongst the richest households, 93 per cent of births involve a skilled attendant. Amongst the poorest, just 31 per cent do. 

Research published in Frontiers in Global Women’s Health found that in 2021, nearly 90 per cent of maternal deaths in Kenya could be attributed to insufficient quality of care, and that only one-third of public health facilities had the capacity to manage basic obstetric emergencies. 

While 98 per cent of Kenyan women received at least one antenatal care visit, only 29 per cent attended during the first trimester – the period of greatest clinical value. Over a third did not complete the recommended four visits. Research in PLOS Global Public Health found that just over 60 per cent of women nationally received what could be classified as quality antenatal care, a figure that drops sharply in the North-eastern region. 

Turkana presents a specific pattern worth attention. The county ranks near the bottom for immunisations and skilled birth attendants, yet records a notably higher position for antenatal visits. Women there appear to be accessing some early prenatal care, but losing contact with the health system at the most critical points,  at delivery, and in the days that follow. This is not a generalised failure of access. It is a specific, identifiable gap in the continuum of care that targeted intervention could address. 

Counties at the bottom of every indicator are places where mothers are dying and infants are unvaccinated  

West Pokot offers a different kind of anomaly. Grouped amongst the counties struggling across most indicators, it ranks second only to Kirinyaga for postnatal checks within 48 hours – the window in which the majority of neonatal deaths occur, and which WHO guidance identifies as critical for detecting complications in both mother and child.  

Something is functioning in West Pokot’s postnatal infrastructure that is not yet translating to skilled births or immunisation coverage. Understanding what that is, and whether it can be replicated or scaled, is precisely the kind of county-level learning that a national health strategy should be built on. 

The broader picture across all 47 counties reveals counties that the headline story of failure can overlook. Nyeri, Nairobi, Nyandarua, Vihiga, and Kiambu cluster near 100 per cent for both skilled births and postnatal checks. Nyeri leads the antenatal visits chart. 

These counties are not footnotes. They are proof that the gap is not inevitable. The counties at the bottom of every indicator are places where mothers are dying, and infants are going unvaccinated at rates that, in 2025, should be unacceptable. The counties at the top show that it does not have to be this way. 

Sources: KNBS 2022, KDHS 2022, WHO, UNICEF, Kenya Ministry of Health, PLOS Global Public Health, Frontiers in Global Women’s Health.  

Data analytics and visualisation by Stanley Njihia & Text by Yvonne Kawira.