Plain English summary
Background
Methods
Study setting
Study participants and recruitment
Data collection and management
Study instruments
Ethical considerations
Data analysis
Results
Characteristic | n (%) |
---|---|
Age in years | |
20–24 | 4 (9%) |
25–29 | 10 (22%) |
30–34 | 13(28%) |
35–39 | 11(24%) |
40+ | 8(17%) |
Marital status | |
Single | 12(26%) |
Married | 34(74%) |
Religion | |
Christian | 42 (91%) |
Muslim | 2 (4%) |
Other/Missing | 2 (4%) |
Ethnicity | |
Luo | 16 (35%) |
Kikuyu | 15 (33%) |
Kamba | 3 (7%) |
Kisii | 2 (4%) |
Luhya | 8 (17%) |
Other | 2 (4%) |
Education | |
Primary | 18(39%) |
Secondary | 32(50%) |
Tertiary | 7(4%) |
None | 2 |
Employment | |
Private Sector | 5 (11%) |
Civil servant | 1(2%) |
Housewife | 23(50%) |
Tailor | 3(7%) |
Trader | 7(15%) |
Other | 7(15%) |
Number of living children | |
0–1 | 5(11%) |
2–3 | 28(61%) |
4–5 | 10(22%) |
5 and above | 3 (7%) |
Characteristics of healthcare workers | ||||
---|---|---|---|---|
Doctors(n = 6) | Nurses(n = 8) | Clinical Officers (n = 2) | Hospital Administrators (n = 4) | |
Age in years | ||||
20–29 | 4 | 1 | 1 | 0 |
30–39 | 2 | 4 | 1 | 3 |
40–49 | 0 | 2 | 0 | 0 |
50+ | 0 | 1 | 0 | 1 |
Marital Status | ||||
Single | 6 | 2 | 1 | 0 |
Married | 0 | 6 | 1 | 4 |
Gender | ||||
Female | 3 | 6 | 0 | 4 |
Male | 3 | 2 | 2 | 0 |
Years of Experience | ||||
0–4 | 6 | 3 | 2 | 0 |
5–9 | 0 | 0 | 0 | 2 |
10–15 | 0 | 3 | 0 | 1 |
15+ | 0 | 2 | 0 | 1 |
Type of health facility | ||||
Private | 0 | 5 | 1 | 4 |
Public | 6 | 3 | 1 | 0 |
Mistreatment experiences of women
Physical abuse
“…At this public hospital the doctors are usually nice, they walk around the wards and when they find you seated, they encourage you to walk. The only problem there is when you disturb them during the delivery process they beat you up, a slap will just land on you or they could beat you up with a plank of wood…” (Woman, age public hospital).
“…I could see how people were giving birth and the doctors were harsh, beating people seriously and you were next and you don’t even know what you were are going to do…” (Woman, aged 23, FGD, delivered in public hospital).
“…You know some mothers are uncooperative because of the pain you find a woman if you are so gentle with them they become unruly but if you are so gentle and so you can find some of them even injuring the baby so you have to be ‘firm’…” (IDI, Nurse-Midwife at private health facility)
Verbal abuse
“…In the wards nurses and workers were shouting at mothers, if they notice that you have soiled the bed sheets you are in trouble; that is the time you are told to wake up quickly and bathe with cold water; and at that time you are weak and can only move slowly…” (Woman, aged 26, FGD, delivered in public hospital).“…I was in labor pains for three days and the nurses were saying that my cervix had not opened and eventually an artificial rupture of membranes was conducted by the nurses who were assisting me… They looked at me with contempt and used abusive language when I was pushing the baby… They could tell me to push or don’t push that really confused me. After a long struggle I told them to take me for an operation because I thought I could not manage [and] the head of the baby was already out. I was terrified to see the nurses hold my legs and forcing me to push the baby, because they had sensed danger. Eventually my baby was safe but I didn’t like how I was handled…” (Woman, aged 24, FGD, delivered in major public maternity hospital).
“…Sometimes maybe a mother has not been attending clinic, she has come with nothing because you have to conduct an ANC profile and know her HIV status. Some are just like they have not gotten any health education outside there. And also primiparous women do not attend clinic.so we have to shout at them…” (IDI, Clinical officer at private facility).
Stigma and discrimination
“…. One looks at a card and sees this is Jane and this is Mary, they would call Jane first (because her name indicates her ethnicity) and she gets attended to with priority and Mary will stay there until at night someone complains (about the queue jumping) and only then do they use the order (in which the patients arrived). This is not right as we are one tribe, just one tribe…” (Woman, aged 30, FGD, delivered at Major Referral Hospital A).
“…They shouldn’t dwell on where one has gone to the antenatal clinic; they get to attend to those who went to private hospitals first and leave those who have been going to the city council hospital. For example at [major maternity Hospital A], those that used to attend city council’s clinic were attend to first while those who were attending private clinics were put aside and they could actually die from there…” (Woman, aged 20, FGD, delivered at a private hospital)
Poor rapport between women and healthcare workers
“…I tried calling the doctor who said I had just arrived [and] it wasn’t still time. … I actually forgot, [and] so I took myself to the ward and climbed into bed. In the process my water broke; they then came started making noise at me asking why I had made the place dirty. When [the nurse] left, the child came out and she just heard the child crying; the child almost slid and fell because of that water. I delivered on my own; they came and assisted me with the cutting [of the cord] but I just delivered on my own…” (Woman, aged 28, FGD, delivered in a public maternity).
“…Because it’s free maternity they think they’ll walk in and walk out with everything for the baby. So most of the times when they come, they come without children’s clothes. So when they come, they find out it’s only the service that is free, everything else they’re supposed to bring for themselves. So this is usually the biggest problem most times …” (IDI, Doctor in Major Maternity Hospital A).
Failure to meet professional standards
“…I called the doctor when I began feeling the baby coming down, but the doctor refused to come and so I delivered on my own. And that is when the doctor was called by the other people. When the doctor came he cut the umbilical cord and before the doctor could attend to me there was another woman nearby also giving birth. The doctor left my child uncovered and unattended and went to the other woman and came back after she had delivered and took my child to the nursery…” (Woman, aged 23, FGD, delivered in a private health facility).
“…At this point there were only two trainees in the ward, one doctor was drunk and was sleeping, when the trainee gets stranded with anything. He comes and when you try to argue with him he beats you up. When I was about to start pushing the baby, the trainee came and was unable to help me. When the doctor came he painfully pressed my stomach and I told him he was hurting me and he said that this was not his work ….His work was to deliver the baby and asked if I hadn’t called for him; but I gave birth well…” (Woman, aged 27, FGD, delivered in Major Referral hospital).
“…I have three kids my firstborn was born at [Maternity hospital A] but I used to go to [small clinic B] where I had high blood pressure so it forced me to attend clinic weekly. On my last weeks of pregnancy I was referred to [Maternity hospital A] where I was examined by students and the real doctors were nowhere to be found. It took me around two hours before I gave birth to a baby was weighing 2.5kg. It made me wonder why they did [an] episiotomy and they also took a lot of time to stitch me. The reasons I was given was that they were waiting for the higher ranked doctors who supervise them to guide them on what or how they should do it. After waiting for a long time they decided to stitch [me]. Unfortunately after 15 mintues, when the doctors came, it was redone. I felt a lot of pain…” (Woman, aged 30, FGD, delivered in Maternity hospital).
Health systems conditions and constraints
“…They should add more nurses. The existing nurses are few in and the patients are many. That’s why they were going from this side to that side and they are tired because they are also looking for a salary increment. If they have good salary they will handle people with care and if they attend to two people they don’t get tired. They should employ more nurses to avoid one nurse attending to 10 patients and to improve their services…” (Woman, aged 22, IDI, delivered at public health facility).
“…The women were seated outside on the bench when one delivers. That is when the other one then gets a bed. The room was small. They could add another room because I don’t know if people are still giving birth as much. The doctors there wanted to assist but the beds were occupied. They would ask if people didn’t want to go elsewhere even though the delivery process there was free. Therefore, women had to wait by the bench; when a woman would report that they were in pain, they would be told to go home and come back the following day; they were unable [to do that] and some would sit by the bench for days. The delivery beds were few…” (Woman, aged 28, IDI, delivered in Maternity Hospital B).“…I don’t know about [Major Maternity Hospital A]. I don’t know what they could add because there were a lot of people during that time. Probably they could add a room as I think they added doctors at [Major Maternity Hospital B]. The room was small; the delivery room was small at that time; it had two beds on one side and two on the opposite side. There were 4 beds in total…” (Woman, aged 34, IDI, delivered in Maternity Hospital A).
“…Sometimes you use ergometrine (medication used to cause contractions of the uterus to treat heavy vaginal bleeding after childbirth) and we don’t have sterile gloves. Sometimes you want to remove a retained placenta, you don’t have the gynecology gloves and you have to improvise. You cut up the other gloves and patch it up. Sometimes in the [operating] theatre you don’t have suturing material… are you serious? It’s something that is quite sad. Sometimes in the middle things can be running smoothly then all of a sudden there is no suture material, there is no water, just like that. There is no water, there is no electricity…” (IDI, Doctor in Major Public Maternity Hospital B).
“…So like I once took a patient to [Public Maternity B]… You see someone [attending to] almost 10 mothers… One mother is calling the other is also calling… In fact they even look as if they are confused. So (they try to hurry), they try to sew one while another patient in the second stage of labor is calling them and its only one nurse. So you find that this time factor makes the stress of work too much. The patient nurse ratio is, I don’t know, it is very, very low. A whole room is just attended by one person. So you just empathize [with their predicament]…” (IDI, Nurse-midwife currently at private facility).
“…They always refer when it’s too late… There are situations where they stay with a mother who has been bleeding for quite a while, so when they see they are not going to help the mother they bring [her] here to our facility… The number one cause for most of the mothers [losing] their lives is postpartum hemorrhage… despite making the necessary interventions on time…” (IDI, Medical officer in public maternity hospital B).
Culture of blame
“…You know generally as human beings, it’s something natural that when someone is grieving, the first person you see is the one you want to blame. […]. And as human beings we always blame the person, then ask questions later. These relatives don’t want to know and most of them don’t understand how the system works…” (IDI, Doctor at Major public Maternity B).“…Makes them less cooperative (laughs) and then complicates the delivery most of the time. Psychologically they get traumatized, you can see them withdrawn and if they have a problem they won’t be free enough to ask you for help because they are not sure how you’d react to them…” (Medical officer in Public Maternity Hospital A).
Additional findings
“…I had to now go to [Mission Hospital A] every other week. They kept examining me to know what the problem was. Everything was relaxing; the doctors are with you all the way; if you begin having pains they ask you what you would want; if you turn this way they apologize; they rub your back. When the baby begins to come out, they come and assist you and if you have to be stitched they do it there. They wash the baby and you also get to shower; they treat people well. I gave birth to all my children there…” (Woman, aged 25, FGD, delivered at Mission Hospital A).