Maternal Healthcare in Kenya - An institutional perspective

Recent studies highlight futile efforts to improve maternal health in Sub-Saharan countries over the years. Kenya is among the countries with the highest burden of maternal deaths in the world, and in East Africa, with huge disparities between the various counties (WHO, 2019). The estimated maternal mortality rate of 342 maternal deaths per 100,000 live births translates to approximately 7,000 maternal deaths each year (WHO, 2019), most of which can be prevented by access to utilization of quality maternal healthcare services. In Kenya, maternal healthcare services are provided by public health facilities, non-governmental organizations, and to a lesser extent, emerging social enterprises. Despite concerted efforts by ongoing maternal health initiatives to increase skilled birth attendance, high maternal mortality persists. Existing research in the developing context demonstrates inequality in women’s and men’s health indicators, life expectancy, education, and command over economic resources - translating to a loss in human development due to gender-based inequalities. Women’s lower education attainment, acquisition of economic resources, and early age at childbirth predict lower agency and well-being. Limited studies have uncovered the maternal healthcare experience in developing countries in relation to agency.

Additionally, there is scarce evidence on the influence of institutions on the maternal healthcare experience. This study explores the role of institutions in influencing women’s agency as a strategy to reduce gender inequality and improve maternal health. The guiding research questions are, “How does women’s agency in health influence their maternal healthcare experience? And, “How do institutions influence women’s maternal healthcare experience?” Data was collected from public, non-governmental, and social enterprise organizations. Ethical guidelines from the Monash University Human Research Ethics Committee and the National Commission for Science, Technology and Innovation of the Government of Kenya were adhered to throughout the data collection stage. A total of 79 interviews with 48 women and 31 health workers were conducted and analyzed using thematic analysis and NVivo software. Preliminary findings revealed three themes that described the maternal health experience in relation to agency: passivity, cultural practices, and maternal education. This research offers a glimpse into institutional perspectives of maternal healthcare in rural, and peri-urban areas in terms of challenges, strengths, and recommendations.