Landmark Ruling in Kenya: A Victory for Respectful Maternity Care

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By: Rhiannon George-Carey, Visiting Fellow, Women and Health Initiative, Harvard T.H. Chan School of Public Health

International Day for Maternal Health and Rights (IDMHR), launched in April 2014 by the Center for Health and Gender Equity (CHANGE) in conjunction with other sexual and reproductive health and rights organizations, advocates for comprehensive, respectful and rights-based maternal health care for all women. This year, IDMHR fell three weeks after a watershed case in which a Kenyan woman was awarded 25,000 USD in compensation by a court in Bungoma, Kenya for the disrespect and abuse she suffered during childbirth in 2013.

Mrs. Josephine Majani had been admitted at Bungoma County Hospital for an induction of labor. Despite a recent national directive instructing all public health care facilities to offer free maternity services, Josephine had to purchase her own induction medication. She received no physical assessment or monitoring during her labor and was told that she had to make her own way to the delivery room if she required medical attention. When Josephine arrived at the delivery room, having walked there alone while experiencing intense labor pains, she found that the beds were all taken. She attempted to walk back to the labor room before collapsing and subsequently giving birth on the floor. Josephine then suffered physical and verbal abuse from two nurses who found her there unconscious and were angry that she had dirtied the floor with her childbirth. She was ordered to walk to the delivery room, again unsupported, to be examined.

Josephine suffered severe emotional trauma following her mistreatment. Sadly, Josephine’s case is not unusual in Kenya, or in fact in many countries around the globe. Evelyne Opondo, Senior Regional Director for Africa at the Center of Reproductive Rights described the situation as “a systemic culture of institutionalized negligence towards women’s health, dignity and human rights, which seems to permeate the country’s health services at all levels.” The findings of a recent study in Kenya exploring the prevalence of disrespect and abuse (D&A) during childbirth supported this statement: 20% of women reported any form of D&A, and 1 in 5 experienced feeling humiliated during labor. D&A can include non-confidential care, non-consensual care, physical abuse, neglect or abandonment and detainment for non-payment of fees. Researchers have identified D&A as a widespread global issue and are working to measure its prevalence around the world.

Kenya has a maternal mortality rate of 510 per 100,000 live births, one of the highest in the world. Causes include lack of funding for maternal health, inadequate training and supervision of health care providers, negligence and unethical practices. As well the D&A described above, many facilities in Kenya lack basic equipment and infrastructure, including electricity and clean water, as well as skilled birth attendants and emergency care capacity. The World Health Organization (WHO) recently published a new intrapartum care guideline which highlights every woman’s right to a positive childbirth experience and respectful maternity care. It brings together new and existing WHO recommendations that, when delivered as a package, ensures high quality care regardless of the setting or resources available. It advances a woman-centered and holistic, human rights-based approach.

This is a landmark case for women, in Kenya and globally, and is an affirmation of their human right to respectful and dignified maternity care.

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