Maternal health has become a major concern across the globe. Back in 2017, I participated in a project on maternal health in Naivasha Sub County Kenya. The government of Kenya had established a policy for free maternity care in public hospitals. It was a good start in the beginning, but later it increased the mortality rate, which was, and still is, affecting mothers while giving birth, babies before delivery and even after delivery.
The government decided to do an observational study in different counties in Kenya to gather data on why the mortality rate had increased. They collected maternity data in several public hospitals through their registers. They discovered that most mothers have stopped delivering at home using the midwives in the villages and hence there is overcrowding in the hospitals.
The data collected showed that the number of staff working in the maternity departments of the hospitals was not enough to handle the mothers registered. The government then came up with the idea of insurance cards that would cover maternity fees in any hospital, be it public or private. Many women started using the cards in private hospitals, but later they stopped.
That is where I joined a maternal health team in A.I.C Kijabe hospital to research why the mothers stopped using the private hospitals. We visited several hospitals and discovered that most private hospitals were empty and public hospitals were overcrowded. We started having focus groups in private and public hospitals in Naivasha Sub County.
Naivasha Sub County consists of different tribes in Kenya, and therefore we would cover most of the communities with different cultures in Kenya. We did months of travel to different communities and hospitals to find answers from the mothers’ themselves.
We met a group of Maasai women in their community, we spoke more on family planning. The women there were against family planning, they explained about the idea of not trusting the Western culture, some said that their spouses were against the idea of family planning. I remember some even chased us away. They told us we should ask permission from the elder of the village to do such talks with them.
Later on, we decided to do a group discussion in the hospital where some Masaai mothers came for antenatal health care. The first group we met was in Mai-Mahiu public hospital. It was a mix of tribes, but we were lucky to meet some of the Masaai ladies. During our focus group discussion we raised some questions and the women opened up to us and explained their fears.
We started the discussion by asking why they were using public hospitals, yet most private hospitals were free too. Most of the women said they were not fully convinced that the private hospitals were free. They said during delivery some mothers would be requested to pay some fee for meals and water. Some mothers explained that the staff at the hospitals would tell them the only thing the government was covering was the medical fee, not food or electricity or water. That was actually a concern to many women during that first discussion.
During the discussion we spoke about family planning. My thinking was maybe the overcrowding in the hospitals could be because of lack of family planning by many women. Some said they use them, but they later ended up pregnant. Some mothers explained more about the medicine, saying they were either expired or not original.
The Masaai mothers spoke as well, we had to get a translator since no one in my team spoke the language. The women explained the cultural belief that the children come from God and the bible says we should procreate. The ladies told us not to speak about that again, so we had to pause and change the topic.
Later on we concluded the discussion and released the women. We still had questions on family planning, but we knew that was a topic for another day. We decided to visit other hospitals around the sub county, but we still got the same answers from the mothers.
A few months later, after several group discussions, we visited Naivasha referral hospital. This was one of the hospitals that was really overcrowded and we were not sure why since A.I.C Kijabe hospital, one of our branches was in that area.
We had a group of 15 women in the hospital to talk to us. We were lucky to even have some caregivers joining the discussion. The mothers here had different views on the subjects. On family planning some said they were using contraceptives, and others said their religion does not allow it.
We didn’t go further on that topic and instead started with the next topic. Here the mothers were more concerned about the expertise of their care staff. They knew the only place they could get the best doctors was in public hospitals. The mothers explained that most private hospitals didn’t have theatres or they didn’t have a doctor at that particular time to perform any surgery in case of any emergency. They explained that they wanted to be near a theatre in case of any complications.
The caregivers explained more about being overwhelmed with the numbers, and they could not get the chance to serve all the mothers. Maybe they were attending to another mother and by the time they reached the next patient the mother would have delivered the baby herself.
The mothers also explained that they had to deliver on the floors unattended, there was sharing of beds in the wards, and that some women were left alone and helped by fellow pregnant women to deliver. We met a few mothers who had gone through all of these things in public hospitals but still went back there instead of to private hospitals because of the access to medical expertise and facilities.
In the end, we understood that the reason for overcrowding in public hospitals was because of the availability of machines, doctors and theatres in public hospitals as opposed to in private hospitals, and also because of the hidden costs of care in private hospitals, and that these two things together had caused the increase in maternal mortality.