Kenya Mothers: Agony of Giving Birth in Public Clinics

Posted on 4 October 2007. Filed under: Affirmative Action, Public Health |

Photo: Tiggy Ridley/IRIN
The women complain of abuse and neglect before and during delivery

NAIROBI, (IRIN) – Margaret Wanjiru would rather forget the experience of having her first baby at one of the public hospitals in Nairobi, Kenya’s capital.

“I remember going to the hospital in 2001. I was in pain, like most of the other women, but we were made to sit on a wooden bench and were not allowed to go into the labour ward without paying,” Wanjiru recalled.

Once in the ward, there were a lot of insults: “You are asked to spread your legs ‘like you did for your husband’,” she said.

According to a report, Failure to deliver, prepared by the Federation of Women Lawyers in Kenya and the Center for Reproductive Rights (CRR), there are numerous challenges facing women in Kenya’s health facilities, including suffering abuse and neglect before and during delivery.

This includes being forbidden to enter hospitals without enough money for a deposit, and not being allowed to have family members on the premises or during delivery, according to the report.

According to Wanjiru, the female nurses are often very cruel, while the men are better.
“They [the nurses] are also old enough to be our mothers so we cannot answer back when they insult us,” she said, “Sometimes they beat you up and say that you are pretending yet you are in pain.”

According to the report, the women are also subjected to unreasonable delays waiting for suturing or to poor stitching. Due to insufficient beds, sharing is common, with those women who fail to pay ending up on the floor.

Free deliveries

The ministry of health has instituted a maternity health waiver allowing for free deliveries in health centres and dispensaries. This is intended to encourage more women to give birth in medical facilities while decongesting hospitals like Pumwani in Nairobi – the largest and busiest maternity hospital in East and Central Africa.

However, Wanjiru is not optimistic. “We were being mistreated even when we were paying, how about now that it is free?”

Elisa Slattery, legal adviser of the CRR’s Africa programme, says the violation of women’s rights in Kenya is widespread, systematic and has been going on for decades.

Women are abused before and after receiving reproductive health services, Slattery said.

Poor record-keeping means increased patient waiting time, with only 23 percent of the facilities conducting reviews of maternal or newborn deaths or near-misses, she said.

Women also often lack access to contraceptives of their choice in some health facilities.

“Women are often abused verbally and physically,” she said. “While motherhood is valued, there are many problems associated with it.”

Photo: Gregory Di Cresce/IRIN
The cost of delivery at a private hospital is prohibitive

Private clinics

The situation is, however, different in most private health facilities, according to Ruth Otieno*, a nurse working at a private hospital in Nairobi.

“We do not keep the women waiting and our labour ward is always ready as our clients are aware of their rights and the kind of service to expect,” Otieno said.

Moreover, at the end of their hospital stay, she said, the clients fill in a questionnaire assessing the quality of care provided.

The cost of a “normal” delivery, without including other charges, such as for the bed and consultation, at a private hospital is a prohibitive 30,000 shillings (US$448).

According to Otieno, the overwhelming burden of delivering many babies daily in public hospitals prevents the nurses from having a one-to-one relationship with the patients. Most public health facilities often lack trained personnel, medical equipment and bed space; in addition, staff are poorly paid.

Women in Kenya have a 1-in-25 lifetime risk of dying from a pregnancy-related cause, with at least 20 percent of all births being unwanted and another 25 mistimed, according to the Kenya Demographic and Health Survey for 2003.

Low morale

The chief clinical officer with the ministry of health, Alfred JBO Odhiambo, said: “The violation of patients’ rights occurs in isolated cases.” He argued that the number of staff should be increased, along with the improvement of salaries and the provision of adequate medical equipment, to improve morale.

More health centres have been opened all over the country to decongest the main hospitals, thus allowing for improved care of patients, he added.

''Women are often abused verbally and physically…while motherhood is valued, there are many problems associated with it''

The hospitals now have a customer relations desk to improve service delivery. “We have made mistakes in the past which we are now correcting.”

The health ministry has seconded some staff to work with the local government ministries responsible for some of the understaffed hospitals.

It is important that the medical personnel have a human touch, he said, adding that the cooperation of patients was also important. “Some of the clients already have negative attitudes towards nurses.

“We are changing how we handle clients and there is now a service charter spelling out what needs to be done across the board,” he said.

According to Slattery, government guidelines on patients’ rights should be disseminated widely so women are aware of their rights.

Recent government efforts to improve public health facilities seem to be paying off, albeit slowly, according to Wanjiru. The hospitals seem cleaner and the nurses help patients make their beds and there are also mosquito nets, she said.

“Since most women lack the funds to go to private health facilities there is a need for improvement of the public ones,” she said.

*Not their real names


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2 Responses to “Kenya Mothers: Agony of Giving Birth in Public Clinics”

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Phil thanks for highlighting the plight of Mothers agony of giving birth in public clinics. This is very common in public hospitals as well. I am very lucky to have got my kids in private hospitals. However I was not happy with the way some nurses handle patients, when the doctor is not around. After my first child’s experience of being handled mainly by nurses in a small private hospital (they were more kind than the ones I hear of in the public hospitals but still I didn’t like it) I opted to go for a private doctor the second time, it is costly and many cannot afford but the male doctor was good. This leaves me wondering don’t these nurses have kids and have gone through the same. I know many nurses who undergo C-section when giving birth, I wonder why?

I came to know about Pumwani from a lady friend who came to live with her husband in Nairobi, she had booked a small private hospital with no theater. When they realized her baby was too big they told her to go to Pumwani. She called her husband who picked her and took her to Pumwani. Apparently the man also did not know about the conditions in Pumwani, They assumed it was ok being the largest maternity hospital in the region. After paying and opening a file, she was ushered in the ward and the husband told to leave. She only came to know the reality when she was already in the ward and labor started progressing. There were no mobiles those days and she could not leave in that conditions. A nurse brought a blood stained hospital gown, which she refused to wear. The nurse got annoyed and said she will give birth on her own and surely when the time came she pushed out the baby, luckily it was her second. The nurses came when other patients screamed. This was a very common scenario in Pumwani and other public hospitals, I have heard of horrible cases of patients delivering even twins on their own and even cases of babies going missing. However cases of babies missing after birth or being claimed to have died may have stopped after Deya case of miracle babies.

With improved health facilities and public clinics being turned to maternity facilities, I hope this has changed. Many women are so scared of going to public hospitals but most have not choice due to poverty.

Reblogged this on Helen's Early Childhood Blog and commented:
Here is the article that I read

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