Additional Reading on Pregnant Women in Kenyan Slums

A) The Mother's Report compiled by University of Nairobi students answers quite a few of the questions we had about why expectant mothers are making the choices they do.

Some things I found most interesting, and important to know before our discussion tomorrow. :
1) Almost all the women understood the need for antenatal visits but did not agree on how many were necessary (some thought less than 4 was sufficient).
2) In overcrowded hospitals, 3 new born babies were forced to share a bed, the mothers opted to put them in their own beds instead. Compare to home delivery where you can be comfortable at home for 2 weeks
3) Immunization is a strong motivation for mothers to seek postnatal care at hospitals. Perhaps we can leverage this desire to get them to come before the birth.
4) When delivery costs are reduced in Kiandutu, almost all the mothers opt to deliver in the hospital.
5) Wife battery: when husbands find out about an unplanned pregnancy, they beat their wives. Chiefs and elders charge the man for unplanned pregnancies (10,000-20,000). Owls and cats are bad omens for death of the child during delivery. Some parents help their children with abortions.
6) If a pregnant woman test HIV+ on the first visit, she's not likely to follow up on her antenatal visits.
7) Teenage romance, and pregnancies tend in dropping out, and high stress if abandoned by the father. (Perhaps we can think of ways to help them cope with school/ make a plan to keep up studies or return while pregnant)
8) Traditional Birth attendants are discouraged and thus kept secret. Some women opt for them because they feel these midwives are friendlier and more helpful than the doctors. Nurses are rude, fear hospitals turn away patients without the right documentation, corrupt doctors etc. One mother describes how the doctor just watched as she had to push alone. (Perhaps it's an issue of midwives understanding or being more in touch with the cultural expectation mothers have for their delivery?)

B) We also referred to the following projects for tips on what was working, and what might be changed.

Project Mwana:




*Using Mobile Technologies to Improve Family Planning, Maternal Health and Newborn Services in Developing Countries:

*Sprout iPhone App:

*Thanks to Mambi for bringing some of these to my attention!

C) For the questions that remained unresolved by the report, I referenced 3 studies (2009) on pregnant women in Kenyan slums, and one on labor complications (2003) prevalent amongst women in rural Kenya.





Some key take-a-ways that changed the direction of our prototype are listed here:

1) Likeliness to recommend or deliver again:
Pregnancy intendedness All Without complications With complications
-Not at all (unwanted) (r)
-Later (mistimed) 2.38**(1.45, 3.90) 2.56** (1.50, 4.37) 1.85 (0.70, 4.86)
-Wanted then 2.75***(1.82, 4.14) 2.90***(1.84, 4.58) 2.30* (1.03, 5.14)

Providers’ empathy
Low (r)
High 3.68***(2.27, 5.97) 3.63***(2.06, 6.40) 4.25*** (2.10, 8.61)

Providers’ quality counseling
Low (r)
High 0.79 (0.48, 129) 0.86 (0.48, 1.53) 0.57 (0.25, 1.30)

Delivery care provider
Nurse/midwife (r)
Doctor 1.29* (1.03, 1.62) 1.24 (0.95, 1.63) 1.50† (0.95, 2.36)

Delivery expenditures (quartiles, KSh)
0–1000 (r)
1001–1350 0.80 (0.56, 1.13) 0.84 (0.57, 1.25) 0.66 (0.31, 1.41)
1351–2000 1.06 (0.76, 1.50) 1.26 (0.86, 1.86) 0.67 (0.35, 1.27)
2000þ 0.91 (0.65, 1.27) 0.91 (0.60, 1.38) 0.80 (0.44, 1.48)

Seems cost not significant for satisfaction.

2) Women can be reached with family planning information and services during antenatal care, which nearly all women in Kenya attend at least once.

3) The first group [of facilities] labeled as "inappropriate", comprised 17 small and often ramshackle and unlicensed
clinics and maternity homes that were deemed unable to offer many of the signal functions of Basic Emergency Obstetric Care (BEOC).

4) ii) Pregnancies that were wanted were more likely to be delivered at health facilities (p < 0.01 in
Panels A and B) or at appropriate facilities (p < 0.01 in Panel A), compared with those that were either mistimed or unwanted.
iii)The number of antenatal visits was associated with place of delivery; women who made the recommended
four visits were more likely to deliver in a health facility in general (p < 0.01) or in an "appropriate" health
facility (p < 0.01), compared to their counterparts who made one or no visits.
iv) Importantly, respondents who were advised during antenatal care to deliver at a health
facility were significantly more likely to use health facilities in general (p < 0.01 in both Panels) and to use the well-equipped ones in particular (p < 0.01 in both Panels),compared to those who were not advised.

5) Women aged less than 25 years were the least likely to deliver at health facilities or at the appropriate ones.

6) There is a strong association between the use of antenatal care services and delivery at a health facility. Interestingly,
women who were advised during antenatal visits to deliver at a health facility were more likely to do so.

7) Out of the total 41,112 deliveries in 2005, 86 percent occurred in three hospitals (the district hospital did not have data) indicating that the majority of normal deliveries, which should be taking place in lower level obstetric facilities did not...Assisted delivery was just about 1.3% further confirming its low availability [8,20]. Additionally, the national referral hospital appeared to have a disproportionately higher case fatality (236 maternal deaths for 6,775 deliveries) compared to the obstetric specialist hospital (25 maternal deaths for 18,943 deliveries).