Abstract
BackgroundIn Kenya, indirectly caused maternal deaths form a significant portion of all maternal deaths within the health system. Many of these deaths are avoidable and occur during delivery and labor. Poor quality health service has been a recurring concern among women in Kenya, with women reporting interactions with healthcare workers that are often demeaning and abusive. This paper explores the experiences and perceptions of both female patients and healthcare workers regarding mistreatment during childbirth. This study aims to provide recommendations on how dignified care can be made the norm, specifically focusing on a peri-urban setting in Kenya.MethodsThe research was accomplished using qualitative research methods with focus group discussions and in depth interviews with women and healthcare workers. The aim was to gain a deeper understanding of the manifestations of mistreatment within the context of a peri-urban setting in Kenya.ResultsFemale patients reported different forms of mistreatment, such as verbal abuse, physical abuse, neglect, discrimination, abandonment, poor rapport and failure of the health system to uphold professional standards. The healthcare workers described a health system that was weak and fragmented with poor policy support particularly for the new free maternity services policy leading to the mistreatment of women.ConclusionNewly formed County Governments need to provide resources for a functioning health system to ensure an enabling environment for the provision of high quality maternal health services. This process can include feedback loops with maternity clients to ensure woman-centered services. Policy makers need to strengthen oversight for the implementation of the free maternity services Community health volunteers can be trained to provide this information. Professional associations that govern the standards of quality care for healthcare workers need to address the mistreatment through retraining and norms transformation.
Highlights
In Kenya, indirectly caused maternal deaths form a significant portion of all maternal deaths within the health system
Previous research in Kenya suggests that women are subject to mistreatment at health facilities, including physical abuse such as slapping and pinching, verbal abuse such as yelling, as well as other acts of abuse and negligence
The study found that mistreatment during facility-based delivery is widespread and is largely driven by weak maternal healthcare policies and poor rapport between different actors within the system, such as mothers, nurses, midwives, doctors, hospital administrators, and the larger healthcare system
Summary
In Kenya, indirectly caused maternal deaths form a significant portion of all maternal deaths within the health system. Many of these deaths are avoidable and occur during delivery and labor. Evidence suggests that a reduction of these deaths can be achieved through the use of a skilled birth attendant during delivery, facility-based delivery and ensuring access to good quality maternal health care [19, 35]. Any examination of maternal mortality must take into account whether deaths were due to direct (e.g. obstetric complications, interventions, use of incorrect treatment, etc.) or indirect causes (e.g. the presence of pre-existing conditions that developed during pregnancy and increased the risk during pregnancy) [36]. Though recent research by van den Akker et al [33] suggests that this distinction needs to be re-examined, as it places too much emphasis on direct causes while ignoring the indirect causes that might, be more significant factors in maternal mortality (see [20]).
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