Maternal mortality in East Africa

Our research began by seeking to understand why pregnancy, childbirth, and the post-natal period in western Kenya were so frequently associated with conflict, anxiety, and neglect.

Jane Plastow’s use of participatory theatre shed new light on the tensions surrounding maternity. Women, by acting out key experiences, were able to reveal the enduring emotional impact of past traumas, and draw out the interpersonal aspects of maternal health problems.

Follow-up interviews and archival research explored key insights from this initial participatory research further, examining the evolving role of grandmothers and mothers-in-law in the field of maternal health, and tracing the historical development of stigma surrounding pregnancy among teenage and ‘geriatric’ mothers, and among poor and uneducated women.

A series of obstacles to the transmission and reception of maternal health information was revealed by Saudah Namyalo’s linguistic research.

Whereas health communication in East Africa in the era of decolonisation had focused heavily on the use of vernacular languages and concepts, by the 2010s medical information in Kisumu and Siaya was typically provided in the English language. While research participants attended ante-natal clinics, they often did so unwillingly, and most sought alternative maternal health guidance in their vernacular language from non-clinical sources.

Maternal health services were marginalised within post-colonial medical systems until the 2000s, when global metricisation and targets highlighted how far Africa’s Maternal Mortality Ratios had diverged from those of the wealthiest nations.

In order to achieve the UN’s Sustainable Development Goal for maternal health, the Kenyan government sought to ensure that all deliveries were supervised by clinically-trained personnel, which in effect required the institutionalisation of childbirth. Rather than lead to the disappearance of the Traditional Birth Attendant, this process has instead seen local midwives present themselves as providing respectful, sympathetic, and culturally-sensitive support to women before and after childbirth, heightening public criticism of what is perceived to be the impersonal, mechanistic nature of maternity services in the clinic.

Wenzel Geissler’s anthropological research examined how Traditional Birth Attendants repositioned themselves in relation to rapidly changing legal restrictions and market opportunities.

When the anthropologist, Benson Mulemi, compared the encounter between staff and patients at ante-natal clinics with how patients behaved at home during follow-up interviews, he was struck by how the clinical relationship was so one-sided.

Pregnant women in their domestic setting asked many questions about their condition, and appeared confident and articulate. In the clinic, they received information, were subject to tests, but rarely did they pose questions nor themselves receive questions or explanations.

Interviews with staff and patients alike indicated that their relationship was commonly regarded as unequal, problematic, and, not infrequently, conflictual. Historical research examined the evolution of this discordance, drawing out the influence of missionary moralism, post-colonial nation-building, and a professional culture that valued endurance, self-sacrifice, and didactic, instructional expression.