On Wednesday 5th of October 2017, Heinrich Boll Foundation in partnership with the Center for Reproductive Rights (the Center) organized a public dialogue on the quality of maternal health care in Kenya. The event was attended by over 130 participants and facilitated by a diverse panel drawn from the national human rights institutions, reproductive rights experts and medical practitioners. The conversation sought to assess the status of maternal health care in Kenya and whether indeed we are on the right track in ensuring that no woman is left behind.
The right to health, including reproductive health is enshrined in a constellation of human rights instruments in Kenya. Article 43 (1) of the Constitution provides that ‘every person has a right to the highest attainable standard of health including reproductive health care. The recently enacted Health Act, 2017 affirms the right to reproductive health care. Section 6 (1) (b) provides for the right to ‘access appropriate health-care services that will enable parents to go safely through pregnancy, childbirth, and the postpartum period, and provide them with the best chance of having a healthy infant’. In 2013, the President issued a directive on free maternity services in public health facilities in Kenya. Four years later, the looming question is on whether the implementation of free maternity policy meets the Accessibility, Availability, Acceptability and Quality of Care (AAAQ’s) threshold. In other words, are pregnant women and girls enjoying quality maternal health care? Are maternal health care services available to all women regardless of their economic status? and are these services acceptable and culturally sensitive to the diverse needs of women in North Eastern, Kainuk among others?
According to the 2014 Kenya Demographic Health Survey, Sixty-one percent of live births in the five years preceding the survey were delivered in a health facility and sixty-two percent were assisted by a skilled provider. These numbers however, are not a reflection of a ‘healthy’ and well-functioning system. Several challenges continue to impede the implementation of free maternity directive. Detention, mistreatment, physical and verbal abuse of pregnant women while seeking maternal health services are common challenges as was discussed in this dialogue. In addition, poor infrastructure, inadequate budget and industrial actions including the recently concluded nurses’ strike continue to deny women and girls the right to quality maternal health care. “We have a country that heavily taxes its citizens but cannot adequately finance the health care system”, one of the panelists alluded. Why is it that when a pregnant woman dies no one blocks the road, yet we can block the roads due to political reasons? asked a participant. When will maternal health become every person’s conversation and how do we involve the grassroots women who are disproportionately affected by these challenges?
Equity in the distribution of health services and interventions is a guiding principle of Kenya’s Health Policy 2014-2030, yet majority of those who cannot access quality maternal health care are women from lower socio-economic status. Nafula (not her real name) was forced to give birth on a floor and had to buy some essentials such as cotton wool, as well as Margaret and Maimuna who were detained in a health facility for failure to pay delivery fees, all clients at the Center for Reproductive Rights are the face of these challenges.
It is not just about inadequate budget, personnel or quality of care: harmful cultural practices and stereotypes also hinder access to maternal health care. Female Genital Mutilation (FGM) remain pervasive despite enactment of the Prohibition of Female Genital Mutilation Act, 2011. In some communities, third party consent is a key determinant of whether a woman will deliver in hospital or not. In others, attitudinal barriers contribute to women and girls shying away from seeking maternal health care services.
How then do we ensure Kenya meets the AAAQs of maternal health and that no woman is left behind? A multi-faceted approach is required. The national and the county government must ensure health facilities are well equipped, with adequate personnel and timely disbursement of funds. Government and civil society organizations should sensitize the public on available maternal health services and capacity build health professionals to respect the rights of women and uphold their dignity. Government must also strengthen its accountability systems and hold to account all those who mismanage maternal health funds. To address reproductive rights violations, government must ensure availability and accessibility of a well-functioning complaints mechanism and appropriate remedy and redress where rights have been violated. In spirit of Sustainable Development Goals (SDGs), leaving no woman behind requires, among others adequate cotton wool, enough beds, skilled nurses and doctors and an assurance of going home after delivery #GenderForum #Justice4Nafula.
This article was authored by Mirriam Nthenge - Advocacy Adviser for Africa, Center for Reproductive Rights.