Council Commentary

Advancing respectful maternity care in Kenya: a comprehensive approach

Kenya was among the countries honored last week during the World Health Organization's annual World Health Assembly for its contributions to enhancing respectful maternity care. The celebration, hosted by the East, Central and Southern African Health Community, followed years of research, partnership, and advocacy spearheaded by the Population Council.

As highlighted by the event, evidence from industrialized and low-and-middle-income-countries suggests that women who give birth in health facilities can face humiliating and undignified conditions—from physical abuse, nonconfidential care, nondignified care, abandonment, and discrimination, to unfair requests for payment. WHO has recognized that the provision and experience of care—how women are treated—are both critical components of quality that can influence service utilization and health outcomes.

Through a consortium with the Kenyan Federation of Women Lawyers and National Nurses Association, Kenya, and support from the U.S. Agency for International Development’s Translating Research into Action (TRAction) Project, the Council led research in 13 Kenyan health facilities to determine the drivers of disrespect and abuse at the policy, facility, and community levels. This was the first time the prevalence of disrespect and abuse was measured and our research helped identify drivers and risk factors in the country. The Council then collaborated with the Ministry of Health (MOH) and partners to implement and evaluate a package of interventions to curb abuse. The results were significant: the interventions were found to reduce the incidence of disrespect and abuse from 20% to 7%. 

Through this research, the Council and its partners gained insights that have since informed policy and practice in the region. For example, we found that health care providers and managers require an "enabling policy environment," but often this is not the case because providers are overworked, poorly compensated, and their efforts go unrecognized. No woman should be pinched, slapped, discriminated against, abandoned, given care without consent, provided nonconfidential care, or be yelled at during childbirth for any reason.  

We found that comprehensive solutions, such as those being developed in Kenya, require action at all levels. At the policy level, our research suggests that improved governance and accountability for women-centered care reduces disrespect and abuse. At the facility level, a supportive environment can help mitigate disrespect and abuse. This includes the provision of adequate equipment and supplies, work areas that offer privacy and confidentiality, space for relatives and providers during childbirth and follow-up care, and psychosocial support and supervision. At the community level, education on reproductive and maternal health rights and responsibilities can enhance women’s capacity to seek maternity services and to demand respect during care. Respectful maternal care requires that all levels of health care work concurrently, because no single effort or intervention can on its own reduce disrespect and abuse.

The Council supported Kenya's MOH  in its scale-up of respectful maternal health interventions in two counties. The MOH is currently scaling up such interventions in 10 additional counties and is aiming to reach 22 counties in 2018. 

While progress in Kenya represents a major step forward, disrespect and abuse appear to be widespread and research and implementation efforts must continue to ensure that all new mothers receive the dignified, positive birth experience they deserve, no matter their circumstances.