Screams of pain can be heard from the room, gasps and heavy breathing follow. Harsh reprimands can be heard in the background.
I hear: “You should have counted the costs before you tried this game.” Momentarily I think someone is paying for a mistake they made. I almost whisper to myself: “serves them right” but a new-born baby’s cry and a sigh of relief make me realise I am standing right behind a hospital’s maternity-wing. A woman has just given birth.
Joyce* clings onto her baby with so much fondness. She has endured too much in the past nine months to be frightened by harsh words from nurses at the infamous Pumwani Maternity Hospital in Nairobi, Kenya. During her antenatal check ups things weren’t any better. She would be screamed at, sent from one room to another, and would be kept waiting for hours.
Despite the obscene insults from nurses still reverberating in her ears she can’t help but smile at the precious bundle in her arms. But one promise she makes: “You are my first and last baby; I can never go through this humiliating episode again!”
In Kenya, comfort and compassion during delivery is an expensive affair. Women who cannot afford to pay for admission to private facilities to deliver are subjected to verbal and physical abuse at the hands of health providers in general hospitals.
In the findings of research carried out by the Center for Reproductive Health-USA and the Federation of Women Lawyers in Kenya (FIDA) between November 2006 and May 2007 to establish the extent of violations to mothers in labour pain, it was evident that women in Kenya have a high risk of dying of pregnancy-related causes and are subject to human rights abuses during pregnancy and labour.
The findings from Failure to deliver prompted the FIDA-Kenya and the Center for Reproductive Health-USA to launch a complaint in 2009 depicting the violation of human rights in Kenyan health facilities. They submitted the complaint to Kenya National Commission on Human Rights (KNCHR) and specifically cited Pumwani Maternity Hospital in Nairobi for a probe. An inquiry on human rights violations in public health facilities was launched last year. Kenyans from many different communities participated in the inquiry whose final report was released in April. During the inquiry women testified on what they had gone through as they were in labour pain.
While in the recommendations of the inquiry it was noted that the government should limit SRH-related costs this remains a huge challenge, and the experience of women attending private and public health care facilities differs greatly as a result. Those women who go to public hospitals will be attended to by over-worked and less compensated health providers. In this case, hostility may occur because the workers are under duress. But in private hospitals the workers will afford compassion to the patients because of the support and motivation they get from their employers.
Dr. Helen Barsosio, a Kenyan medical practitioner, says that while in theory every woman has the right to give birth in dignity in reality this option only exists for the educated and economically well-off. This group of women not only have the money to buy their comfort while delivering but can also voice their grievances should their rights be violated.
Dr. Barsosio says that, while every medical practitioner is under oath to treat all patients with respect and dignity, the same code of ethics can easily be overlooked by a tired, poorly compensated health worker.
Cases of women delivering at the hospital gates assisted by gate-keepers or passersby because they could not afford the admission fees have commonly been reported. Women have lost children or even their lives in such circumstances while their feminine dignity remains trampled on. Dr. Barsosio says that it is sad that Kenyan hospitals have such a sorry reputation and adds that medical practitioners are trained to save lives, hence they should make this their priority.
The KNCHR inquiry report recommends the removal of financial barriers to ensure the services referred to by the government as ‘free’ remain so in reality. Cases where a service is referred to as free only for patients to then be asked to pay for it are common in many public hospitals.
Many women have resorted to traditional birth attendants who are kind and gentle to them and also affordable. Campaigns have been going on to empower traditional birth attendants to act as an alternative to those women who cannot afford private hospitals. But medical practitioners have argued that traditional birth attendants expose themselves to the risk of getting infected should their clients have HIV and do not have the training to deal with the issue of mother to child transmission or other complications. Yet despite TBAs having scant knowledge and experience they are preferred to public hospitals in many rural areas.
“I would rather go to a traditional birth attendant than to a trained nurse in a public hospital. Traditional birth attendants are much more ethical than the nurses!” said one woman who spoke from an ugly experience she had in a public hospital.
Joyce* is not her real name