Most of our health insurance policies in Kenya are designed to grossly discriminate against women’s reproductive health needs.
What you need to know:
- How can CS be capped at Sh30,000, yet the same NHIF is willing to pay Sh120,000 for a prostatectomy?
- The same insurance that will pay Sh150,000 for the delivery and refuse to pay for contraceptives which will not cost anything more than Sh20,000 a year and will avert the need to spend on delivery.
- In essence, private insurance is a business and they have to stay afloat.
Diane stood at five feet and at full term pregnancy, she weighed a measly 54kg.
This tiny bundle was so full of energy looking forward to motherhood. Despite her tiny size, she was all geared up to go through labour. She was fully aware of the limitation of her tiny size and the high possibility of a caesarian section, but she remained optimistic.
The D-day arrived in style. Diane broke her waters while at work, three days before her due date. Her colleague Brian* rushed her to hospital as she lamented about soaking his car seat.
Her husband Solomon* was hyperventilating in the noon traffic as he headed to the hospital from his office across town. He had failed to convince her to take maternity leave early and his worst fears had been realised; that she would go into labour at work.
By the time Diane was being settled into the ward, she had given up trying to correct everyone about Brian not being her husband.
Solomon arrived in time to handle the real labour. The contractions had set in and Diane was verbalising each one of them. Brian had never felt so relieved to hand over.
Good contractions
Four hours after admission, Diane’s labour appeared to be on course. The baby was expected in another two hours and it looked like she just might surprise us.
However, two hours later, it was clear that we had celebrated too soon. Her progress had stalled and despite good contractions, the cervix was no longer dilating.
The baby’s scalp was beginning to swell, a sign it was getting obstructed from descending further.
Having laboured for six hours, Diane was determined to deliver normally and we gave her two more hours under close observation. The baby remained stable throughout, but there was no more progress.
It was time to throw in the towel. Diane was now exhausted and ready to end this. She underwent a CS and successfully delivered a girl who weighed 3.4kg. Diane’s pelvis was too small to allow her little one through, a condition known as cephalopelvic disproportion.
Despite having a medical insurance cover paid by her employer, having a CS meant she overshot her maternity cover provision and the couple had to pay the difference. This is despite having an inpatient cover limit of Sh2 million that remained untouched.
Four years later, the couple were ready to expand their family. Diane sailed through the pregnancy with her usual bubbly energy and was ready for delivery by C-section.
She was aware that her physical stature had not changed and that cephalopelvic disproportion was not a condition to resolve. I advised her to find out about her medical insurance provisions so as to be able to plan early.
The insurance company was adamant it was not going to pay for a CS since it only covered the first operation. Diane was aghast. In the four years since her last delivery, her family had never needed to use the inpatient cover. Yet here she was, a faithful contributor to her policy through her employer and yet she could not benefit from it. She was heartbroken.
Potentially life-threatening
It is time to call this conversation to order. Most of our health insurance policies in Kenya are designed to grossly discriminate against women’s reproductive health needs. This is where the majority of the exclusion criteria fall.
These policies will cap the maternity benefits at ridiculously low
amounts yet it is an in-patient healthcare service like any other.
The
National Hospital Insurance Fund (NHIF) followed suit when it was
costing maternity services for the Linda Mama programme, grossly
compromising care and sinking many level five and six hospitals into
debt as they attempt to provide service.
As a specialist performing caesarian sections, I fail to understand how it can be capped at Sh30,000, yet the same NHIF is willing to pay Sh120,000 for a prostatectomy. Both are major surgical procedures and caesarian delivery is even more delicate considering there are two lives involved.
How did we decide that women are this indispensable?
What is even more ridiculous is how the same insurance that will pay Sh150,000 for the delivery will flat out refuse to pay for contraceptives which will not cost anything more than Sh20,000 a year and will avert the need to spend on delivery.
Right up until a decade ago, these companies would claim to pay for maternity care, but decline to pay for a miscarriage or an ectopic pregnancy, both being pregnancy related and potentially life-threatening.
In essence, private insurance is a business and they have to stay afloat. However, if this is at the expense of a gender that constitutes 50 per cent of our population, it is not only immoral, but also grossly in violation of chapter four of the Constitution.
It brings to life a statement by Prof Mahmoud Fathalla in 2006: “Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving: We have not yet valued women’s lives and health highly enough.”
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