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: http://projectmwana.
FrontlineSMS: http://www.
MobileActive: http://
txtAlert: http://www.
*Using Mobile Technologies
to Improve Family Planning, Maternal Health and Newborn Services in
Developing Countries: http://www.icohere-
*Sprout iPhone App: http://topapps.eu/sprout-
*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.
DeliveryCareSatisfaction-
EmergencyObstetrics-
MothersAutonomy-
LabourComplications-Rural2003.
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).