Abstract
BackgroundThis study analyzes the consequences of maternal death to households in Western Kenya, specifically, neonatal and infant survival, childcare and schooling, disruption of daily household activities, the emotional burden on household members, and coping mechanisms.MethodsThe study is a combination of qualitative analysis with matched and unmatched quantitative analysis using surveillance and survey data. Between September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy that led to the death; schooling experiences of surviving school-age children; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions. Quantitative data on neonatal and infant survival from a demographic surveillance system in the study area were also used. Descriptive and bivariate analyses were conducted with the quantitative data, and qualitative data were analyzed through text analysis using NVivo.ResultsMore than three-quarters of deceased women performed most household tasks when healthy. After the maternal death, the responsibility for these tasks fell primarily on the deceased’s husbands, mothers, and mothers-in-law. Two-thirds of the individuals from households that suffered a maternal death had to shift into another household. Most children had to move away, mostly to their grandmother’s home. About 37% of live births to women who died of maternal causes survived till age 1 year, compared to 65% of live births to a matched sample of women who died of non-maternal causes and 93% of live births to surviving women. Older, surviving children missed school or did not have enough time for schoolwork, because of increased housework or because the loss of household income due to the maternal death meant school fees could not be paid. Respondents expressed grief, frustration, anger and a sense of loss. Generous family and community support during the funeral and mourning periods was followed by little support thereafter.ConclusionThe detrimental consequences of a maternal death ripple out from the woman’s spouse and children to the entire household, and across generations.
Highlights
This study analyzes the consequences of maternal death to households in Western Kenya, neonatal and infant survival, childcare and schooling, disruption of daily household activities, the emotional burden on household members, and coping mechanisms
A qualitative study in Tanzania [10] described the impact of a maternal death on a range of survival, nutritional, health and other intergenerational outcomes for children, while research in rural Haiti found that a family with a maternal death had a 55% higher odds of experiencing a death to a child under age 12 years, but that there were no increased odds for child mortality in the case of nonmaternal adult deaths
Ethical approval The study is a collaborative effort between Family Care International (FCI), the International Center for Research on Women (ICRW), and the KEMRI/CDC Research and Public Health Collaboration, a partnership between the Kenya Medical Research Institute (KEMRI) and the U.S Centers for Disease Control and Prevention (CDC)
Summary
This study analyzes the consequences of maternal death to households in Western Kenya, neonatal and infant survival, childcare and schooling, disruption of daily household activities, the emotional burden on household members, and coping mechanisms. This paper contributes to filling this gap by analyzing the consequences of maternal death for child health, child survival and household functioning in a region of Kenya. The death of an adult family member can have significant negative impacts on children’s survival, health and schooling [2,3]. A qualitative study in Tanzania [10] described the impact of a maternal death on a range of survival, nutritional, health and other intergenerational outcomes for children, while research in rural Haiti found that a family with a maternal death had a 55% higher odds of experiencing a death to a child under age 12 years, but that there were no increased odds for child mortality in the case of nonmaternal adult deaths. The authors of the Haiti study concluded “...a maternal death has a more significant impact on children and families than the non-maternal death of a woman of reproductive age” ([11]; p400)
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