Saving Mothers has recently begun a partnership with HealthRight International in Kenya, working to improve maternal and child health in West Pokot, an extremely underserved county on the Western edge of the country. Since the new constitution was ratified in 2009, the Kenyan government has renewed it's focus on improving health outcomes around the country, with special emphasis on maternal and child health. This effort has included providing free antenatal and maternity care at public hospitals. Unfortunately these changes are rolling out very slowly, and maternal and child mortality rates remain appallingly high in West Pokot. Lack of resources is only the tip of the iceberg when it comes to poor health among pregnant women and newborns; access to care is still the primary reason health outcomes in the West Pokot population remain inadequate.
Sociocultural inhibitions play a significant role in preventing women in West Pokot from seeking medical care in a hospital setting. Many women feel safer or more comfortable delivering in their home with traditional birth attendants or even lay people than with hospital staff in an unfamiliar setting. Unfortunately these attendants are typically unskilled or inadequately equipped to recognize complications and intervene appropriately. Even many of the women who do elect to visit hospitals for antenatal care will still choose to deliver at home.
Women in West Pokot often view hospitals as inaccessible from a social standpoint. Female gential cutting or "female circumcision" is a widespread practice in West Pokot, and women who have been circumcised often fear that hospital staff will ridicule them or force them to undergo a cesarean section if they opt to deliver in a hospital. Fear of disrespectful care in general is a large issue preventing women from seeking medical interventions. Stories and rumors about hospital staff hitting laboring women and performing episiotomies without anesthesia serve to widen the ideological gap between hospitals and the populations they intend to serve in West Pokot.
The paramount access issue that prevents pregnant women from seeking antenatal care and giving birth in a hospital setting is physical distance. West Pokot is a vast and sparsely populated country where many women need to travel up to 90km to get to the nearest public hospital. Transportation is also a problem as roads in West Pokot are very poorly maintained, and public transportation or taxis can take hours to travel even short distances. This transportation can also be prohibitively expensive.
For both concrete and abstract reasons there is a large gap between hospitals and the population of West Pokot. Hopefully as maternal and child heath availability improves with the new resources offered by the Kenyan government, this population and the hospitals that serve them will learn to integrate their perspectives in effectual ways in order to bridge this divide.