COMMUNITY-BASED CARE FOR MATERNAL HEALTH AMONG PASTORALISTS IN LAIKIPIA, KENYA

Abstract

Morbidity and mortality related to pregnancy and childbirth are major priorities in the field of global health today. In the year 2013, nearly 300,000 women died as a result of obstetric complications, most of which are preventable with proper diagnosis and treatment. 99% of maternal deaths occur in low-resource settings and over half in sub-Saharan Africa, starkly reflecting global disparities in the distribution of resources and health services.

This study focuses on maternal healthcare utilization in a rural and historically underserved population, the Mukugodo Maasai pastoralists of Laikipia County in the Rift Valley Region of Kenya. Access to healthcare in these communities is remains low for a number of reasons, from the limited availability of transportation in the area to the continued prevalence of traditional birth practices and the semi-nomadic lifestyle of the Maasai. In recent years, a variety of initiatives intended to improve maternal health have been initiated, including the removal of user fees for maternity care, training of community health workers, training of traditional birth attendants, and provision of hygienic birth kits.

Quantitative and qualitative methods were used to analyse women’s reported experiences with healthcare during pregnancy and childbirth. Additionally, a mathematical model was created to explore the dynamics of the uptake of a health-promoting behaviour in this community under conditions representing different interventions. The model shows that delivery in a health facility will eventually be accepted as a norm by the majority of the population. In reality, this outcome will also depend on factors that are slower to change, such as building the capacity of the health system in the area. Survey responses show that while interventions aimed at education for behaviour change have made an impact on women’s attitudes towards maternal healthcare, their actual rates of skilled attendance at birth have not significantly increased as a result. Overall improvement of maternal health in this region will call for a nuanced, context-dependent approach that addresses people’s practical needs as well as their deeply held beliefs.