Free Maternity Services in Kenya: Do They Include Respectful Maternity Care?
Unlike many of its neighboring countries, where progress has been made toward the MDG 5 target of increasing the proportion of births with a skilled birth attendant (SBA), Kenya has struggled. In fact, the country experienced a reduction in the percent of births attended by SBAs: from 50% in 1989 to 44% in 2010. This has contributed to an excessively high maternal mortality ratio of 488 deaths per 100,000 live births, leaving it off track to meet MDG 5 by the 2015 deadline.
In an effort to address this issue, the newly elected Jubilee Government included the promise of free maternity services at public facilities in its 2013 campaign and officially abolished user fees in June of this year. While there has been much celebration of the free maternity services policy and the historic gains made for women’s rights in general, many members of civil society and the public at large have expressed skepticism about the impact this will have on reducing maternal mortality, and anecdotal evidence suggests mothers have avoided the free maternity services fearing that quality of care will decrease.
Even though the new policy removes an important financial burden, it does not fully address the numerous deterrents to receiving care that women must overcome in order to access services. In addition to known geographic, financial and cultural barriers, research conducted by the Kenyan Federation of Women Lawyers, Family Care International and the Population Council has shown that disrespectful and abusive care from providers serves as a major deterrent to the decision to deliver in health facilities in Kenya. These studies show that many women choose to deliver at home because they fear the inhumane treatment they may experience if they go to the hospital. Under the new policy, respectful maternity care remains a concern, as women who access the free services may risk be subjected to humiliating or degrading treatment by health care providers and hospital staff.
The new policy does not account for measures necessary to accommodate the expected increase in demand: additional investments are needed to increase the number of facilities or expand existing facilities’ capacity; ensure availability of supplies and equipment; and train health workers to provide respectful maternity care. Additionally, the policy does little to address the persistent shortage in human resources for health—an issue that has recently been compounded by a health worker strike.
In short, removing user fees plays a key role in reducing financial barriers, but does not ensure that women will make the decision to deliver in health facilities, with assistance from SBAs, nor guarantee that the care they receive will be delivered with respect.
Kenya’s 2010 Constitution provides for human dignity and the right to life. In providing free maternity services, the Jubilee Government has taken laudable steps towards protecting women’s right to health and in ensuring that financial barriers will not prevent women from accessing care in facilities. However, much more remains to be done to guarantee the Constitution’s claim of the right to human dignity, especially with regard to women’s experience of childbirth in health facilities.