Disrespect and Abuse: Do Poor Kenyan Women Suffer More?

Session: Differentials in the Utilization and Quality of Maternal and Newborn Care: Uncovering Inequities

Presenter: Charlotte Warren, Population Council
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Background:   Financial barriers (formal and informal) continue to deter pregnant women from seeking care, but fear of disrespect and abuse (D&A) during facility-based childbirth also influences women’s decisions of where to give birth leading to low uptake of maternity services. The Heshima project in Kenya sought to understand the prevalence of D&A, as well as what interventions might mitigate the drivers of D&A in 13 health facilities and surrounding communities.

Methodology: A cross-sectional survey conducted in 13 facilities measured the prevalence of types of D&A among 641 postpartum women. Socio-economic status (SES) was assessed using a wealth index generated from household assets/amenities using principle component analysis. Chi square test was used to compare differences in proportion of reported D&A incidents between wealth quintiles. Qualitative interviews were also conducted with policy, health system and community level participants.

Results: Postpartum women (20%) reported feeling disrespected during labour and/or delivery. Comparisons of D&A prevalence across all wealth quintiles was not significant, but there was significant difference in D&A reported by the poorest 20% compared to the richest 20% [p<0.001] . The poorest women reported feeling abandoned (16% versus 6%) and being detained for non-payment (5.5% vs. 12.4%), but did not report more physical abuse (0% vs. 2.3%) or requests for bribes (0% vs. 0.8%). Informal payments were reported by community members to ensure that clients get fast treatment, specialized care and privileges such as not sharing beds. Additional qualitative findings will provide context for the drivers of D&A.

Conclusion: Analyzing inequity using wealth quintiles may mask differences in D&A experienced by women delivering in health facilities. Although differences were found between the highest and lowest wealth quintiles, other factors may also contribute to women’s experiences and therefore it is important to think beyond SES to ensure pregnant women receive comprehensive equitable maternity care.