Informal settlement areas with their numerous challenges (high insecurity, insufficient clean water supplies, food shortages, poor maternity services, poor housing and poor waste disposal/ hygiene etc.) remain to be homes for many underprivileged women in Kenya. It is however more disturbing to realize that most of these women live with other serious conditions and risks which further makes them vulnerable by diminishing their control over their health and that of their newborns

By Reagun Andera Odhiambo

Population & Reproductive Health Expert

Nairobi, Kenya

Bundle of Joy or Cause for Shame?

Just What Mothers in the Kenyan Informal Settlements Face

A Tale of Inequalities in Maternal Health Service Delivery

 

 

Motherhood in the African context

For most African cultures, motherhood remains the primary source of women’s self-esteem and public status leave alone personal fulfilment. Culturally, having children and nurturing them into responsible adults is the primary index of the worth of women. The inability of a woman to give birth to and raise children therefore deprives her of the pride that comes with being a mother and may imply that she does not meet her life-long purpose. This should not be the case especially bearing in mind that some factors leading to such outcomes are out of control of the woman.

Culture aside, having a healthy baby is one of the biggest joys of life. Ideally, babies should bring hope, happiness and purpose to parents. This is however not the case always owing to the fact that some parents lose their babies from preventable causes related to pregnancy and its management, diseases or accidental causes. The grief of losing a baby is a heartbreaking and immeasurable encounter. When your baby dies from a miscarriage, stillbirth or at/after birth, your hope of being a parent dies too. The dreams you had of holding your baby and watch them grow fade leaving an empty space inside you; this may take a long time to heal.

The death of a mother for reasons related to pregnancy and childbirth is not any better. This is because a mother’s love being irreplaceable, losing her to a preventable death is an extremely painful and unforgettable experience.

The Kenyan informal settlements situation

The risk of a woman dying from complications of pregnancy and childbirth over the cause of her lifetime in Sub-Saharan Africa stands at 1 in 160 See. The same risk stands at 1 in 3,700 in high income countries. Over the years, downward trends in childhood mortality in slums have been witnessed across Africa. This has been solely attributed to intra-urban disparities in health, environmental factors as well as social conditions.

In Kenya for instance, rapid growth of urban populations in a context marked by inadequate urban planning and limited service provision has led to mushrooming of shanty towns and slums (Mukuru, Kibera, Mathare, Kawangware, Lang’ata, Ngando etc.) See. Typically, such areas have poor housing conditions, inadequate water supplies and sanitation infrastructure, poor livelihood opportunities and limited education, health and other fundamental social services. Rapid slum population growth points to the likelihood that maternal and newborn health indicators in the Kenyan slums are likely to determine the respective national health indicators.

Often, health facility delivery is a proxy for skilled birth attendance; an important intervention in reducing maternal and neonatal mortality. Sadly though, most expectant women living in the Kenyan slum areas (Mathare, Mukuru, Kibera, Kawangware, Ngando etc.) still do not utilize facility based maternity services right from prenatal care. For most of them, lack of essential newborn care items such as baby clothes, soap, comfortable newborn beds etc. presents an immediate and more serious hurdle which blinds them from an even more serious impending danger presented by out of facility delivery.

Parenting for such women remains to be a challenging and painful experience which leaves them with depressive thoughts, stigma and feelings of being failures. On a broad spectrum, parenting involves taking responsibility in nurturing children and relating to them in a manner that prepares them to attain their full potential in life. Parenting makes great emotional demands and thus requires exceptional interpersonal skills. Supporting a child right from birth through to adulthood while looking into their physical, emotional, social and intellectual well-being is a demanding task which often goes unrewarded.

Majorities of women living in the Kenyan slums do not complete at least four of the recommended eight ANC visits during pregnancy. Worse even, a large proportion still delivers at home with the help of unqualified and unskilled birth attendants. The main reason for this high risk behavior is the fear of judgement, discrimination and stigmatization presented to underprivileged women in health facilities for reasons of lacking basic newborn care essentials (baby clothes, towels, blanket/shawl etc). These women shun from facility-based care for the fear of being tormented by nurses and birth attendants something which leaves deep scars of regrets, shame and guilt. The reality that such women cannot offer the recommended basic care to their newborns causes them to feel less important and failures in nurturing children. The truth of the matter is that such women live with bitterness and regret giving birth because it is the newborns that bring the unanticipated shame and hopelessness.

Special risk groups of women living in slums

Informal settlement areas with their numerous challenges (high insecurity, insufficient clean water supplies, food shortages, poor maternity services, poor housing and poor waste disposal/ hygiene etc.) remain to be homes for many underprivileged women in Kenya. It is however more disturbing to realize that most of these women live with other serious conditions and risks which further makes them vulnerable by diminishing their control over their health and that of their newborns.

Teen mothers

Teenage motherhood remains to be a serious problem in Kenya mostly rooted with urban slums and contributing significantly to the maternal and newborn mortality estimates. The problem manifests at teenage which is a crucial phase of growth and development during which young people make choices that define their health and well-being for life. In Kenya, the problem poses a significant obstacle to the attainment of a number of key SDGs, (goal 3 on healthy lives and well-being for all at all ages, goal 4 on equitable quality education for all and goal 5 on gender equality and empowering women and girls). This is because it denies the girls the right to enjoy quality life with the minimum possible health risks and vulnerabilities. The problem imposes huge costs on the lives of the young people and ultimately affects their future reproductive health life.

For slum dwelling teens, motherhood presents every possible pain and stress which to some can only be dealt with through abortion, suicide or abandoning the newborn- all of which are wrong and seriously detrimental choices. The lack of newborn care essentials, leave alone food and appropriate shelter is a serious burden which cannot be handled by a teen mom owing to her young age and limited knowledge.

Expectant women and mothers living with HIV/ AIDS

Living with HIV/AIDS as an expectant mother can be challenging and full of uncertainties. Living in a slum with all these uncertainties can be unbearable and a reason for hopelessness and desolation. Women living with HIV need specialized care, proper diet, protection as well as love and affection. These are often lacking in informal settlements which on the contrary are full of social crimes and insecurity, poor housing/ living conditions, poor sanitation and worse of all inaccessibility to quality healthcare including emergency obstetric care. Newborns to these infected women may be at an increased risk for infection and may lack proper nutrition right from birth. They may also lack affection, something that contributes greatly to their development.

Mothers living with chronic conditions/ Non-Communicable Diseases (NCDs)

With the current high incidences of Non-Communicable Diseases, many women living in slum areas are becoming victims of these life-long and detrimental conditions (cancers, high blood pressure, diabetes, chronic heart disease etc.). The management of such conditions requires huge sums of money and the adoption of healthy lifestyles all of which are almost impossible for slum dwellers owing to their low incomes and few health options. Being pregnant or a nursing mom only adds up to the devastation of such women causing them to feel inadequate and incapable of satisfying their societal and personal obligations.

Expectant women and mothers living with disability

Being disabled in one way or the other and living in a slum can be challenging. Expecting a newborn in such an environment only adds up to the many challenges and worries of a woman. A disabled mother needs care and support to carry out her normal activities, having a newborn increases this need and makes the mother and her newborn vulnerable to both individual and external factors.

Homeless expectant women/ mothers

Owing to many reasons (mostly economic), some women may find themselves without homes within informal settlements. They have no shelters/place to sleep and thus keep shifting positions within congested streets hoping for a better day. Having a baby for such a woman is a troubling encounter which cannot be described enough. The circumstances surrounding the lives of such women and their newborns can prompt life-long social and psychological effects which can be hard to rectify.

Why Facility-based care is a lesser option

For many slum dwellers, facility based maternal care is a lesser option – a reason for the high maternal and child mortalities in such areas. Among the reasons for the low uptake of available health services include; high costs and service fees which makes it unaffordable, fear of judgement and stigmatization for lack of birth preparedness, negative perception of the importance of ANC, fear of being diagnosed with other serious ailments (which would mean extra treatment costs) and view of pregnancy/ childbirth as a normal risk-free process.

Conclusion

Expectant women and newborns living in slums have various special needs ranging from safety and protection, need for clean water, sufficient food supplies, emergency obstetric services and quality maternity care, proper housing and most importantly male involvement and support. In addition to this, they require dignified care with zero tolerance to discrimination and stigmatization. All efforts should be geared towards mass education on the importance of ANC and facility delivery. Heath service delivery systems should be strengthened to ensure each individual has access to quality and affordable care tailored to their specific needs. Also, economic empowerment and poverty eradication strategies should be focused on informal settlements as this would curb the main underlying drivers of poor maternal and newborn health outcomes in such areas.