Deliver on your own: Disrespectful maternity care in rural Kenya

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Study Justification:
– The study aims to address the persistently high maternal and infant mortality and morbidity rates in Kenya, despite the implementation of the Free Maternity Policy (FMP).
– It seeks to understand women’s experiences of disrespectful care during pregnancy, labor, and delivery, which can inform the development of interventions to improve the standard of care and health outcomes for women and newborns.
Study Highlights:
– The study found that nursing and medical care during labor and delivery in rural Kenya can be disrespectful, humiliating, uncompassionate, neglectful, or abusive.
– Women giving birth preferred male health workers, perceiving them as more friendly and sensitive.
– Adolescent females were more likely to report abuse during maternity care, while women with disabled children reported being stigmatized.
– Structural barriers related to transportation and available resources at facilities were identified as contributing to disrespectful care.
Study Recommendations:
– Focus on quality and compassionate care to increase the use of facility care and improve health outcomes.
– Allocate more resources to maternity facilities to address the identified structural barriers.
– Implement, enforce, and monitor quality of care guidelines for pregnancy and delivery, including respectful maternity care.
– Establish measurable benchmarks for maternity care and regularly monitor hospitals to ensure these benchmarks are achieved.
Key Role Players:
– Ministry of Health (MOH)
– Local government representatives
– Religious leaders
– Community health committee members
– Local women’s organizations
Cost Items for Planning Recommendations:
– Training programs for healthcare providers on respectful maternity care
– Infrastructure improvements in maternity facilities
– Transportation services for pregnant women
– Equipment and supplies for maternity care
– Monitoring and evaluation systems for quality of care benchmarks

Background: Under the Free Maternity Policy (FMP), Kenya has witnessed an increase in health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more needs to be done. Aim: Using data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project’s qualitative gender assessment, this paper examines women’s experience of disrespectful care during pregnancy, labour, and delivery. The goal is to promote an improved understanding of the actual care conditions to inform the development of interventions that can lift the standard of care, increase maternity facility use, and improve health outcomes for both women and newborns. Methodology: We conducted sixteen focus group discussions (FGDs), two each for adolescent females, adult females, adult males, and community health committee members. As well, twenty-four key Informants interviews (KII) were also conducted including religious leaders, and persons from local government representatives, Ministry of Health (MOH), and local women’s organizations. Data were captured through audio recordings and reflective field notes. Research site: Kisii and Kilifi Counties in Kenya. Findings: Findings show nursing and medical care during labour and delivery were at times disrespectful, humiliating, uncompassionate, neglectful, or abusive. In both counties, male health workers were preferred by women giving birth, as they were perceived as more friendly and sensitive. Adolescent females were more likely to report abuse during maternity care while women with disabled children reported being stigmatized. Structural barriers related to transportation and available resources at facilities associated with disrespectful care were identified. Conclusions: A focus on quality and compassionate care as well as more facility resources will lead to increased, successful, and sustainable use of facility care. Interpreting these results within a systems perspective, Kenya needs to implement, enforce, and monitor quality of care guidelines for pregnancy and delivery including respectful maternity care of pregnant women. To ensure these procedures are enforced, measurable benchmarks for maternity care need to be established, and hospitals need to be regularly monitored to ensure these benchmarks are achieved.

Based on the findings of the study, the following recommendations can be developed into innovations to improve access to maternal health:

1. Comprehensive training programs: Develop and implement training programs for healthcare providers that focus on respectful and compassionate care during pregnancy, labor, and delivery. This training should address issues of disrespect, abuse, neglect, and stigmatization reported by women in the study. It should also emphasize the importance of patient-centered care and the rights of pregnant women.

2. Strengthen community engagement: Engage community health committee members, religious leaders, and local women’s organizations in promoting respectful maternity care. Conduct awareness campaigns and community dialogues to educate the community about the importance of respectful care and encourage them to hold healthcare providers accountable for their behavior.

3. Improve facility resources: Address the structural barriers identified in the study by improving transportation options and ensuring that facilities have adequate resources to provide quality care. This may involve increasing the availability of medical supplies, equipment, and skilled healthcare providers in rural areas.

4. Establish quality of care guidelines: Develop and enforce guidelines for pregnancy and delivery that include specific standards for respectful maternity care. These guidelines should be based on best practices and should be regularly updated to reflect evolving evidence and feedback from women and healthcare providers.

5. Monitor and evaluate: Establish a system for monitoring and evaluating the quality of maternity care in healthcare facilities. This can include regular assessments, audits, and feedback mechanisms to ensure that the established benchmarks for maternity care are being met. Hospitals should be held accountable for providing respectful care, and appropriate actions should be taken if benchmarks are not achieved.

By implementing these recommendations, it is expected that the standard of care will be lifted, leading to increased facility use for maternity care and improved health outcomes for both women and newborns.
AI Innovations Description
Recommendation: Based on the findings of the study, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Implement comprehensive training programs: Develop and implement training programs for healthcare providers that focus on respectful and compassionate care during pregnancy, labor, and delivery. This training should address issues of disrespect, abuse, neglect, and stigmatization reported by women in the study. It should also emphasize the importance of patient-centered care and the rights of pregnant women.

2. Strengthen community engagement: Engage community health committee members, religious leaders, and local women’s organizations in promoting respectful maternity care. Conduct awareness campaigns and community dialogues to educate the community about the importance of respectful care and encourage them to hold healthcare providers accountable for their behavior.

3. Improve facility resources: Address the structural barriers identified in the study by improving transportation options and ensuring that facilities have adequate resources to provide quality care. This may involve increasing the availability of medical supplies, equipment, and skilled healthcare providers in rural areas.

4. Establish quality of care guidelines: Develop and enforce guidelines for pregnancy and delivery that include specific standards for respectful maternity care. These guidelines should be based on best practices and should be regularly updated to reflect evolving evidence and feedback from women and healthcare providers.

5. Monitor and evaluate: Establish a system for monitoring and evaluating the quality of maternity care in healthcare facilities. This can include regular assessments, audits, and feedback mechanisms to ensure that the established benchmarks for maternity care are being met. Hospitals should be held accountable for providing respectful care, and appropriate actions should be taken if benchmarks are not achieved.

By implementing these recommendations, it is expected that the standard of care will be lifted, leading to increased facility use for maternity care and improved health outcomes for both women and newborns.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be used:

1. Baseline data collection: Collect data on the current state of maternal health access, including facility utilization rates, maternal and neonatal mortality and morbidity rates, and women’s experiences of disrespectful care. This can be done through surveys, interviews, and data from health facilities and government records.

2. Intervention implementation: Implement the recommended interventions in selected healthcare facilities or communities. This can include training programs for healthcare providers, community engagement activities, improvements in facility resources, establishment of quality of care guidelines, and monitoring and evaluation systems.

3. Data collection after intervention: Collect data on the impact of the interventions on access to maternal health. This can include facility utilization rates, changes in maternal and neonatal mortality and morbidity rates, and women’s experiences of care. Data can be collected through surveys, interviews, and data from health facilities and government records.

4. Data analysis: Analyze the data collected before and after the intervention to assess the impact of the recommendations on improving access to maternal health. Compare facility utilization rates, maternal and neonatal mortality and morbidity rates, and women’s experiences of care before and after the interventions to determine if there have been significant improvements.

5. Evaluation and interpretation: Evaluate the findings and interpret the results to understand the effectiveness of the interventions in improving access to maternal health. Assess whether the recommended interventions have led to increased facility use, improved health outcomes for women and newborns, and a reduction in disrespectful care.

6. Recommendations and scaling up: Based on the findings, make recommendations for scaling up the interventions to other healthcare facilities or communities. Identify any challenges or barriers encountered during the implementation and suggest strategies for overcoming them.

By following this methodology, researchers can assess the impact of the recommended interventions on improving access to maternal health and make evidence-based recommendations for future interventions and policies.

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