The role of medical interventions in maternal health during and after childbirth in Kibera slums of Nairobi, Kenya

Abstract

Childbirth is one of the biggest events in a woman's life. In developed countries, essential medical interventions are conducted by medical doctors, and this helps to keep maternal and infant mortality rates low. This is not the case in developing countries like Kenya, where deliveries are facilitated mainly by poorly equipped and trained midwives and traditional birth attendants (TBAs). The outcome of this is high maternal and newborn mortality rates.

This study examined the kinds of medical interventions available to women during delivery; their suitability in terms of accessibility; and effects of such medical interventions of their absence on the health and lives of women in Kibera slums.

It was a cross-sectional study, carried out in Kibera slums, Nairobi City, Kenya, between July 2002 and June 2003. The target sample population comprised 400 consenting women residents who had had babies before. In addition, 10 medical personnel were recruited into this study as Key Informants Interviewees (KII) to provide specialized information and 6 unmarried young women participated in Focus Group Discussions (FGDs) to enlighten the research on common ideas about childbirth. The data was collected using questionnaires and interview guides. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) software, while qualitative information entailed content analysis.

The results showed that poverty was prevailing in this area and the low level of education hampered access to health facilities. Therefore, women preferred to deliver in free and familiar atmosphere assisted by TBAs. Hence only about 26.3% of delivery cases considered medical intervention during and after childbirth in the Kibera slum area.

Most of the medical interventions (61.9%) carried out during childbirth were episiotomies and caesarian sections, which promoted easy and safe delivery of the baby. The main reasons for the interventions were to save oversized babies, breech babies, multiple pregnancies and cord problems. Some cases were taken for help out of necessity. Natural childbirth was respected in this area.

The deliveries that required medical intervention affected the women's life both physically and mentally. This had an enduring or long lasting effect on the quality of life of the women. Quite a number of women (33.3%) who were given medical intervention at delivery had a bad memory of their childbirth.

Getting a baby is one of the biggest events for women who get pregnant. But not all of the women (90.2%) in Kibera have a good memory of delivery for some reasons.

The results of this work could be useful for all pregnant women, medical persons who are concerned with delivery, and all of their supporters who should select the situation of delivery, what and how they should react to childbirth. This study should also help in the planning and implementation of maternal-child health services and programmes in Kibera slums.