Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

Abstract

17 Background: Under the Free Maternity Policy (FMP), Kenya has witnessed an increase 18 health facility deliveries rather than home deliveries 19 with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal 20 outcomes. Despite these gains, maternal and infant mortality and morbidity rates in 21 Kenya remain unacceptably high indicating that more work needs to be done. 22 Aim: Using data from the Access to Quality Care through Extending and Strengthening 23 Health Systems (AQCESS) project's qualitative gender assessment, this paper 24 examines and describes women's experience of disrespectful care during pregnancy, 25 labour and delivery. The goal is to promote improved understanding of actual care 26 conditions in order to develop interventions that can lift the standard of care, increase 27 maternity facility use, and improve health outcomes for both women and newborns. 28 Methodology: We conducted sixteen focus group discussions (FGDs) with female 29 adolescents, women, men and community health committee members. Twenty four key 30 informants interviews (KII) including religious leaders, local government representatives, 31 Ministry of Health (MOH) and local women's organizations were conducted. Data were 32 captured through audio recordings and reflective field notes. 33 Research site: Kisii and Kilifi Counties in Kenya. 3 34 Findings: Findings show Nursing and medical care was sometimes disrespectful, humiliatings, 35 uncompassionate, and neglectful. In both sites, male health workers were the most preferred by women 36 as they were friendly and sensitive. Young women were more likely to be abused and women with 37 disabled children were stigmatized. 38 Conclusions: Kenya needs to enforce the implementation of the quality of care guidelines for pregnancy 39 and delivery, including respectful maternity care of pregnant women. To make sure these procedures are 40 enforced, measurable benchmarks for maternity care need to be established, and hospitals need to be 41 regularly monitored to make sure they are achieved. Quality of care and compassionate and 42 caring staff may lead to successful and sustainable use of facility care. 43

Maternal Disrespect and Abuse by Health Care Providers among postpartum women attending Mizan-Tepi University Teaching Hospital, South West Ethiopia

“…The discrepancy might be due to good commitment of health care professionals against physical abuse. This finding is similar with studies conducted in Pakistan and India on women's experiences of mistreatment during facility based childbirth (22,23) The odds of maternal disrespect and abuse among mothers who gave birth at night shifts were 2.2 times higher than those who delivered at day shifts [AOR=2.21; 95% CI:1.306, 3.772 ].This finding in line with study conducted in Kenya (17). In line with this, qualitative study conducted in Ethiopia revealed disrespectful and abusive care were more common during night shifts(4) .…”

“…This could be due to the lack of appropriate physical barriers like curtains at health facilities and/or poor understanding of the importance of confidentiality during childbirth among healthcare providers. This finding is high from the study which was conducted in urban Tanzania and Kenya (17,18).This difference might be due to data collection methods. The previous studies found data from direct observation of mothers during labor and delivery.…”

Disrespect and abuse of women during the process of childbirth at health facilities in sub-Saharan Africa: a systematic review and meta-analysis

“…This substantial difference between the studies could lack of standardized definitions, instruments and study methods in a study designed disrespect and abuse during the childbirth processing at health facilities introduced the potential error in reporting estimated prevalence, affected generalizability and comparability [ 49 ]. Furthermore, this difference might be the women preferred health care providers could be preferred male in some place [ 50 ] and others could be preferred female health care providers. Besides, disrespect and abuse as normalized and internalized by both health care providers and women considered as a normal event, the way of data collection like self administration, interview and observation [ 39 ], sampling technique, sociocultural difference and way of defining of disrespect and abuse care within the studies.…”

Existing barriers to utilization of health services for maternal and newborn care in rural Western Kenya

“…For the newborn care, there is a need for warmth, feeding support, safe oxygen use, prevention of infections etc. [26] and for the maternal, there is a need for respectful maternity care [27,28] and proper referral guidelines especially for high-risk pregnancy to a tertiary centre of prenatal care [29]. However, gaps still exists at the rural health facilities especially on the maternal care and cost-effective low-tech equipment for newborn care [26,30,31] and implementation of the referrals.…”