Exploring women’s childbirth experiences and perceptions of delivery care in peri-urban settings in Nairobi, Kenya

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Study Justification:
– Kenya has a high maternal mortality rate and slow progress in improvement.
– Peri-urban settings in Kenya have higher rates of maternal death during labor and childbirth.
– Access challenges and poor maternal health service quality contribute to women giving birth outside of health facilities.
– Most studies focus on sociodemographic determinants, but few assess women’s experiences and perceptions of quality of care during childbirth.
– Understanding women’s experiences can lead to person-centered strategies and improvements in satisfaction and maternal health outcomes.
Study Highlights:
– Qualitative study conducted with 70 women in peri-urban Embakasi, Nairobi.
– In-depth interviews with women who gave birth in public and private health facilities.
– Four main themes emerged: positive experiences with person-centered care, negative experiences of mistreatment.
– Positive experiences included responsive, dignified, supportive care with respectful communication.
– Negative experiences included non-responsive care, non-dignified care, lack of respectful communication, and lack of supportive care.
– Findings provide a holistic understanding of person-centered maternity care in the informal settlement context.
Recommendations for Lay Reader and Policy Maker:
– Improve person-centered care to ensure positive facility-based childbirth experiences.
– Enhance responsiveness, dignity, support, and respectful communication in maternity care.
– Address mistreatment issues such as poor reception, long wait times, verbal and physical abuse, lack of privacy and confidentiality, denial of companions, neglect, abandonment, and poor facility environment.
– Implement strategies to structure the provision of maternity care to be person-centered.
Key Role Players:
– Ministry of Health, Kenya
– Public and private health facilities
– Health professionals (doctors, nurses, midwives)
– Community health workers
– Non-governmental organizations (NGOs) working in maternal health
– Women’s advocacy groups
Cost Items for Planning Recommendations:
– Training programs for health professionals on person-centered care
– Improvement of facility infrastructure and environment
– Hiring and training additional staff to reduce wait times
– Awareness campaigns on women’s rights and respectful maternity care
– Strengthening referral systems between health facilities
– Monitoring and evaluation systems to assess the implementation and impact of person-centered care

Background: Kenya continues to have a high maternal mortality rate that is showing slow progress in improving. Peri-urban settings in Kenya have been reported to exhibit higher rates of maternal death during labor and childbirth as compared to the general Kenyan population. Although research indicates that women in Kenya have increased access to facility-based birth in recent years, a small percentage still give birth outside of the health facility due to access challenges and poor maternal health service quality. Most studies assessing facility-based births have focused on the sociodemographic determinants of birthing location. Few studies have assessed women’s user experiences and perceptions of quality of care during childbirth. Understanding women’s experiences can provide different stakeholders with strategies to structure the provision of maternity care to be person-centered and to contribute to improvements in women’s satisfaction with health services and maternal health outcomes. Methods: A qualitative study was conducted, whereby 70 women from the peri-urban area of Embakasi in the East side of Nairobi City in Kenya were interviewed. Respondents were aged 18 to 49 years and had delivered in a health facility in the preceding six weeks. We conducted in-depth interviews with women who gave birth at both public and private health facilities. The interviews were recorded, transcribed, and translated for analysis. Braune and Clarke’s guidelines for thematic analysis were used to generate themes from the interview data. Results: Four main themes emerged from the analysis. Women had positive experiences when care was person-centered—i.e. responsive, dignified, supportive, and with respectful communication. They had negative experiences when they were mistreated, which was manifested as non-responsive care (including poor reception and long wait times), non-dignified care (including verbal and physical abuse lack of privacy and confidentiality), lack of respectful communication, and lack of supportive care (including being denied companions, neglect and abandonment, and poor facility environment). Conclusion: To sustain the gains in increased access to facility-based births, there is a need to improve person-centered care to ensure women have positive facility-based childbirth experiences.

This qualitative study was part of a mixed-method study of person-centered maternity care amongst women living in the informal settlements of the Embakasi area in Nairobi City, Kenya. The quantitative study is aimed at measuring PCMC using a validated scale to assess its impact on children’s developmental outcomes. The qualitative study described women’s childbirth experiences to assess their perceptions of PCMC and what contributed to positive and negative experiences, to provide a more holistic understanding of PCMC within the informal settlement context. Embakasi is the most populous peri-urban area in Nairobi with a population of almost one million people. It is divided into five sub-counties; Embakasi-East, Embakasi-North, Embakasi-West Embakasi-South, and Embakasi Central. The area is characterized by low-income housing, informal settlements with poor access to water and waste disposal. The largest garbage fill for the city of Nairobi is situated in one of the sub-counties, Embakasi-East. The residents who live in this area belong to the lowest wealth quintile in Kenya, and there is widespread poverty and high unemployment. The health system consists of public maternity hospitals, health centers, and private faith-based health facilities. Faith-based health facilities are owned and run by religious groupings and are classified as private health facilities by the Government. The main public referral health facility for maternity services is a hospital in Embakasi-West.

Based on the information provided, here are some potential innovations that could improve access to maternal health in peri-urban settings in Nairobi, Kenya:

1. Mobile health clinics: Implementing mobile health clinics that can travel to peri-urban areas, providing essential maternal health services such as prenatal care, postnatal care, and family planning. This would help overcome the challenge of poor access to health facilities in these areas.

2. Telemedicine: Introducing telemedicine services that allow pregnant women in peri-urban areas to consult with healthcare professionals remotely. This would provide access to medical advice and guidance without the need for physical travel to a health facility.

3. Community health workers: Training and deploying community health workers in peri-urban areas to provide basic maternal health services, education, and support. These workers can act as a bridge between the community and formal healthcare system, improving access and awareness of maternal health services.

4. Public-private partnerships: Collaborating with private healthcare providers to expand access to maternal health services in peri-urban areas. This could involve subsidizing services or establishing referral systems between public and private facilities to ensure comprehensive care.

5. Improving facility infrastructure: Investing in the improvement of public health facilities in peri-urban areas, including upgrading equipment, ensuring a clean and safe environment, and addressing issues of overcrowding. This would enhance the quality of care and encourage more women to seek facility-based births.

6. Addressing socio-economic factors: Implementing programs that address the underlying socio-economic factors contributing to poor maternal health outcomes, such as poverty and unemployment. This could involve providing economic opportunities, vocational training, and social support to women in peri-urban areas.

It is important to note that these are potential recommendations based on the information provided. Further research and analysis would be needed to determine the feasibility and effectiveness of these innovations in improving access to maternal health in peri-urban settings in Nairobi, Kenya.
AI Innovations Description
Based on the findings of the qualitative study, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Implement person-centered care: The study found that women had positive experiences when care was person-centered, which included being responsive, dignified, supportive, and with respectful communication. To improve access to maternal health, health facilities should prioritize person-centered care by training healthcare providers on effective communication, empathy, and respectful treatment of women during childbirth.

2. Address mistreatment and abuse: The study identified mistreatment and abuse as a significant barrier to accessing facility-based births. To address this issue, health facilities should establish and enforce policies that prohibit mistreatment and abuse of women during childbirth. Training programs should be implemented to educate healthcare providers on the importance of respectful and dignified care.

3. Reduce wait times and improve facility environment: The study highlighted long wait times and poor facility environment as negative experiences for women. To improve access, health facilities should streamline their processes to reduce wait times and ensure a comfortable and clean environment for women during childbirth. This can include optimizing staffing levels, improving infrastructure, and implementing efficient appointment systems.

4. Enhance privacy and confidentiality: Lack of privacy and confidentiality was identified as a negative experience for women. Health facilities should prioritize privacy and confidentiality by providing separate spaces for consultations and examinations, ensuring that conversations cannot be overheard, and implementing strict protocols for handling patient information.

5. Increase access to companions: The study found that women felt unsupported when denied companions during childbirth. Health facilities should revise their policies to allow women to have a companion of their choice during labor and delivery, as this can provide emotional support and improve the overall childbirth experience.

By implementing these recommendations, health facilities can work towards improving access to maternal health by ensuring that women have positive facility-based childbirth experiences. This, in turn, can contribute to increased satisfaction with health services and improved maternal health outcomes.
AI Innovations Methodology
Based on the information provided, here are some potential recommendations for improving access to maternal health in peri-urban settings in Nairobi, Kenya:

1. Strengthening facility infrastructure: Improve the physical infrastructure of health facilities in peri-urban areas, including upgrading equipment, ensuring a clean and safe environment, and addressing issues related to water and waste disposal.

2. Enhancing human resources for health: Increase the number of skilled healthcare providers, particularly midwives and obstetricians, in peri-urban areas to ensure adequate coverage and quality of care during childbirth.

3. Improving transportation and referral systems: Develop efficient transportation systems and referral networks to facilitate timely access to health facilities for pregnant women in peri-urban areas, especially during emergencies.

4. Community engagement and awareness: Conduct community-based awareness campaigns to educate women and their families about the importance of facility-based births, the availability of maternal health services, and the benefits of person-centered care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current state of access to maternal health services in peri-urban areas, including the number of facility-based births, distance to the nearest health facility, availability of skilled healthcare providers, transportation options, and community awareness.

2. Modeling the interventions: Use a simulation model to estimate the potential impact of each recommendation on improving access to maternal health. This could involve creating scenarios that vary the implementation of each recommendation and assessing the resulting changes in key indicators such as the number of facility-based births, travel time to health facilities, and availability of skilled healthcare providers.

3. Data validation: Validate the simulation model by comparing the model’s predictions with real-world data from peri-urban areas in Nairobi, Kenya. This could involve conducting surveys or interviews with women who have recently given birth in these areas to gather information on their experiences and access to maternal health services.

4. Sensitivity analysis: Conduct sensitivity analysis to assess the robustness of the simulation model and identify key factors that influence the impact of the recommendations. This could involve varying input parameters such as population size, healthcare provider availability, and transportation options to understand how different scenarios affect access to maternal health.

5. Policy recommendations: Based on the simulation results, provide policymakers and stakeholders with evidence-based recommendations on which interventions are most likely to have the greatest impact on improving access to maternal health in peri-urban areas. This could include prioritizing certain recommendations based on their potential effectiveness and feasibility of implementation.

By using this methodology, policymakers and stakeholders can make informed decisions on how to allocate resources and implement interventions that will have the greatest impact on improving access to maternal health in peri-urban settings in Nairobi, Kenya.

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