Stop mistreating us during childbirth, women demand

Esther Nyawira’s two childbirth experiences were a whirlwind of emotions, both marked by similar parallels.  At 19, in 2018, she welcomed her firstborn son and three years later, her daughter.

 “My first pregnancy was a challenging and emotionally taxing experience. There was a lot of societal stigma and condemnation because no one expected me to get a baby at such a tender age, and I felt like I was a disappointment to them. The overwhelming shame and fear of judgement deterred me from seeking prenatal care. By the time I was going to the hospital for delivery, I had not done any of the essential antenatal check-ups,” she recounts. 

During her first childbirth experience, she says she encountered blatant rudeness emanating from some nurses. “Then, I rationalised what was happening as a consequence of failing to attend antenatal clinics and blamed myself,”  she offers. 

As she approached the hospital for her second childbirth, she brimmed with joy at the prospect of becoming a mother again, this time having attended all the required antenatal check-ups. Yet, her happiness was shadowed by the disheartening treatment she encountered at the hospital. 

“I would ask questions pertaining to my health and the procedures and some of the responses I got were sarcastic or mockery. In one instance after the delivery, I vividly remember questioning a procedure that they wanted to carry out. I was adamant that I wanted to understand it before allowing them to proceed. To my disbelief, one of the hospital cleaners, who was aiding the nurses keep me still, silenced me with a slap. What was even more distressing was that the nurses remained silent, offering no defence or support. It was a harrowing experience. Fortunately, my cries for help did not go entirely unheard. A gynaecologist was eventually summoned and he took the time to listen to my concerns and helped me understand why I needed the procedure,” she reflects. 

Nyawira’s story is not an isolated incident. A recent survey conducted by White Ribbon Alliance Kenya, a movement for women’s health and rights, has shed light on the issue. The organisation conducted a Respectful Maternal Care (RMC) listening exercise in three primary counties—Kisumu, Narok, Kakamega, revealing that a significant number of women share Nyawira’s sentiment. Responses from Vihiga County, also included in the data, were captured in response to engagement challenges with the primary counties occasioned by political interference. 

The women’s primary demand? Respect. The exercise engaged 3,212 women and girls. Overall, 42 per cent expressed a collective desire for healthcare providers, particularly nurses and midwives, to treat them with dignity, empathy and understanding. 38 per cent of women and girls demanded quality services. Three per cent of the respondents advocated for more efficient and shorter waiting times when accessing healthcare services. 

Being served in a respectful manner was the top priority in Kisumu, Narok and Kakamega counties. But in Vihiga County, the top demand was accessing quality services, at 51 per cent. 

In some cases, the women emphasised the importance of being attended to in a manner that ensured their personal matters were not disclosed to other medical staff or fellow patients by the attending nurses. In other cases, the women reported being shouted at or having their requests denied.

 The Centers for Disease Control & Prevention describes mistreatment in the context of maternity care as the absence of respectful and considerate treatment, or the failure to provide care that upholds a woman’s dignity, safeguards her privacy and confidentiality, guarantees her safety from harm or ill-treatment and facilitates her ability to make informed choices, all while ensuring uninterrupted support throughout the labour and childbirth process. 

“We spoke to a diverse group of women from different socioeconomic backgrounds, adolescent mothers, women with disabilities and first-time mothers. We sought to hear the real experiences of women and girls because respect and dignity is a key component of providing quality care and a critical indicator of maternal and newborn healthcare. Our approach is premised on the belief that when policy, programmes and resource allocation decisions are driven by and are reflective of women’s and girls’ self-expressed needs, quality and dignity is improved,” says Angela Nguku, founder and executive director, WRA Kenya. 

The report reveals that 39 per cent of the 1,015 health service providers, including midwives, community health workers and policy makers, demanded that women and girls be handled and served in a friendly manner. 

The World Health Organization recommends good-quality and evidence-based care irrespective of the setting or level of health care and emphasises the importance of creating an environment where women feel heard, valued and safe during pregnancy, childbirth and postpartum care.

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