Addressing disrespect and abuse in childbirth in Kenya

As I walked through the reception area of our office in Bungoma last week, a shocking newspaper article caught my eye titled ‘The Hell that is Delivery Rooms’.

While the title was sensational, I turned the page and found that the substance was very real.

The article is based on a recent scientific paper published in the journal BMC Pregnancy & Childbirth, about the manifestations and drivers of mistreatment of women during childbirth in Kenya. The full paper summarises the findings from qualitative research conducted in 2011.

The authors have used their existing data to tell us more about a reality we would rather not talk about: the fact that women are abused, neglected and detained all across Kenya when they give birth. They are slapped for not pushing hard enough, verbally abused for being from the wrong tribe, and ignored completely for being too poor. To add insult to injury, both nurses and women give reasons to justify abuse, indicating that these practices have become normalised in the health system. Sadly, physical abuse is often explained as being acceptable in the interests of a ‘safe delivery’.

This mentality is captured in several quotes, including this one from a nurse:

“The issue of mothers saying nurses are bad must be dealt with in the community. They should be informed that nurses are not bad. Ideally any mother who has delivered in a hospital is slapped on the thighs to facilitate or encourage her to push because if the mothers do not push the danger is obvious”.

The UK government-funded Maternal and Newborn Improvement (MANI) project is working in partnership with the Bungoma County Department of Health to directly tackle this important issue. Rather than sweeping the problem under the rug, Bungoma county has set an example for the country by stepping out boldly to say that these practices must change.

Throughout last year, MANI supported Bungoma to kick start a rights-based approach to maternity care. Eighty-seven health workers, facility managers and board members have been trained in respectful maternity care to date. Training participants have shared their observations of disrespect and abuse saying ‘It is very frequent. We see it happen daily.’

In addition to training, MANI is supporting community scorecard meetings where community members and health workers meet to track performance and implement solutions, as well as the provision of ongoing debriefing support for health workers. In 2017 MANI will also support the government to conduct regular client exit interviews to capture the prevalence of disrespect and abuse after training, and to feed this real time data back into the quality improvement processes at health facilities.

Last year on this day I called on all of us to recognise that failures in the health system play a role in creating the working conditions in which health workers mistreat their clients. This remains true. As summarised by one of our training participants,

 “We are doing our best on the ground but we have no support. We are working under a lot of stress.” … “We are so overworked, with no time to rest. In my facility many times I work 24 hours because there is no one else and if I don’t work the community complains and I will lose my job. So I just hold on, knowing that I am not giving it my best.”

This year, as we read the detailed findings in the BMC publication, I would also like to call on my fellow nurses to think deeply. While we are overworked, we must also stop hiding behind excuses, and we must hold each other accountable. I believe that deep down, we all know that is it wrong to slap a woman in labour, to pinch her to make her listen.

When we open ourselves to this honest self-reflection, we see a painful truth – summarised here by one of our training participants in Bungoma:

“It was so touching going through the activity when I recall what I have been doing to my patients because it is so real … we are going to stop that, we feel bad about it. I can’t believe I am part of this system. It’s unbelievable”.

Change must happen at all levels, and the individual level starts with us. On this international day for maternal health and rights, let us agree that all Kenyan women have the right to a childbirth where they are not slapped, a childbirth where they are treated with respect. Let us roll up our sleeves together to make this right a reality.

This blog was written by: Options’ Team Leader Nicole Sijenyi Fulton