Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

Adelaide Lusambili, Aga Khan University
Violet Naanyu, Aga Khan University
Terrance J. Wade, Brock University
Lindsay Mossman, Aga Khan Foundation
Michaela Mantel, Aga Khan University
Rachel Pell, Aga Khan Foundation
Angela Ngetich, Aga Khan Foundation
Kennedy Mulama, Aga Khan Foundation
Lucy Nyaga, Aga Khan University
Jerim Obure, Aga Khan University
Marleen Temmerman, Aga Khan University


Background: Under the Free Maternity Policy (FMP), Kenya has witnessed an increase 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 work 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 and describes women’s experience of disrespectful care during pregnancy, labour and delivery. The goal is to promote improved understanding of actual care conditions in order to develop 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) with female adolescents, women, men and community health committee members. Twenty four key informants interviews (KII) including religious leaders, local government representatives, Ministry of Health (MOH) and local women’s organizations were conducted. 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 was sometimes disrespectful, humiliatings, uncompassionate, and neglectful. In both sites, male health workers were the most preferred by women as they were friendly and sensitive. Young women were more likely to be abused and women with disabled children were stigmatized.

Conclusions: Kenya needs to enforce the implementation of the quality of care guidelines for pregnancy and delivery, including respectful maternity care of pregnant women. To make sure these procedures are enforced, measurable benchmarks for maternity care need to be established, and hospitals need to be regularly monitored to make sure they are achieved. Quality of care and compassionate and caring staff may lead to successful and sustainable use of facility care.