| dc.description.abstract | This is a qualitative study of women's responses to pregnancy and childbirth among a
selected sample of women in Nyang'oma division of Bondo district. In the study, close
examination of the socio-cultural, economic, physical and service factors associated with low
antenatal and postnatal health care services utilization patterns are examined. Pregnancy is
put under a cultural microscope and the arena in which it is experienced examined.
The analysis is based on one year's field work (July 2002-July 2003) funded by DANIDA
through KEDAHR on maternal health care in a socio-cultural context. The research involved
a questionnaire survey involving one hundred mothers who had given birth in the last one
year prior to the survey and a maternal cohort of twenty five(25) pregnant women recruited
in their 4th and s" months of pregnancy and followed initially weekly and later fortnightly
beyond delivery and up to six weeks after delivery. The research also conducted key
informant interviews, provider interviews, client-provider observations, direct facilities
observations and the direct observations in the community on how pregnancy as a process is
lived and experienced.
The results reveal low antenatal health care utilization patterns and even more low postnatal
health care practices. It is also apparent that the division has very low maternal health care
coverage and few facilities. The low utilization of services is attributed to several factors key
among them is the power relational dynamics and the negative effects of culture that limits
the female choices and reduces the woman to a spectator in her own pregnancy, the cultural
definition of pregnancy as a normal natural condition rather than a pathological one that
requires medical care. Analysis of the qualitative data resulting from the longitudinal followup,
case studies and the narratives amplifies the female voices and reveals a pattern where
low antenatal care services utilization results from a variety of factors. These inciude
poverty, low maternal education/awareness, provider based inefficiencies, the poor
infrastructure and the availability of competing/complementing but familiar alternatives that
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lend well to the cultural definitions of pregnancy.
Equally emerging is the reinforcement of the fact that pregnancy and the whole question of
reproduction is not solely a biological affair, but rather a socially constructed process
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reinforced by the political and economic conditions prevailing in the environment in which it
is experienced. The results from the previous Kenya Demographic Health Surveys (KDHS,
1993; 1998 and 2003) reveal a pattern of a very high antenatal attendance; however, the
research indicates that the high cases observed in the surveys are examples of women who go
to the clinics once for the sole sake of getting an antenatal card as 'security or passport to the
unknown'. Most women cushion themselves against the possibilities of being turned away
from health care facilities during delivery in the event of any obstetric complication, as the
antenatal card is the passport to professionalized care. While the majority of women reported
that they went for clinic at least once, there is a clear pattern of resistance that attempt to
show women as conscious agents of their actions in trying to resist the medicalization of
pregnancy and childbirth.
The emergence of home deliveries as a common practice and the preferred place by most
women amplifies further this resistance as women want to be in-charge of their destiny
without the biological intrusion of the professionals (most likely men). Home deliveries are
seen to accord women the control over their own bodies and the entire process is mostly in
the hands of women- the parturient woman, her female kin and the midwives. Luo culture
even discouraged the presence of the husband at birth.
With respect to the safe motherhood interventions, the research recommends that the
definition of reproductive health needs to be widened beyond the female person and beyond
issues of pregnancy, delivery and contraception. The entire cultural arena in which
conception happens, pregnancy is carried to term and delivery finally takes place needs to be
revisited other than the present concentration in the improvement of antenatal health care
facilities and the continued medicalization of pregnancy and training of health care
personnel. An entirely holistic approach with the empowerment of women at the core and
harnessing the beneficial aspects of culture are considered to be the best ways out of the
maternal health burden. | en |
