College of Social and Behavioral Science
89 Listening to Midwives Working in an Informal Settlement in Kenya: Implications for Policy Making
Chrizelle Ransom and Marissa Diener
Faculty Member: Marissa Diener (Family and Consumer Studies, University of Utah)
Literature Review
Almost eight hundred women died every day in 2020 from preventable causes related to pregnancy and childbirth (World Health Organization [WHO], 2023). Ninety-five percent of those deaths occurred in middle to low-income countries. The World Health Organization has identified well-trained and educated midwives as capable of averting eighty percent of maternal deaths, stillbirths, and neonatal deaths (WHO, 2023).
In Kenya, over 83% of maternal and newborn care is provided by midwives (WHO, 2016). In 2014, the United Nations Population Fund estimated that the current Kenyan midwifery workforce will only meet 61% of the country’s needs by 2030 and that the nurse, midwife, and physician graduation rate would need to double in order to meet 97% of the need in the same year (United Nations Population Fund [UNFPA], 2014). Additionally, in the same report, a 9% midwifery attrition rate was noted, indicating a need to not only train new clinicians but also increase workforce retention.
Further convoluting the midwifery workforce landscape is low adherence to labor and delivery care quality standards (Impwii et al., 2023). In 2016 the World Health Organization released Standards for improving quality of maternal and newborn care in health facilities, a document aimed at aiding maternal and infant healthcare workers in providing evidence- based routine and emergency care (WHO, 2016). Contributing factors leading to low adherence were overwhelming workloads, lack of appropriate supplies, lack of knowledge, and unavailability of physical copies of the standard-of-care documents in the facilities (Impwii et al., 2023). A review by Kimani & Gatimu (2023) agreed that outmigration and underinvestment exacerbate the midwifery workforce shortage in Kenya.
In 2013 the Kenya government aimed to improve access to maternal and infant healthcare for all citizens by removing all user fees associated with such care. This was known as the Linda Mama policy and was intended to cover prenatal, labor, and postpartum care. However, in practice, facilities were only reimbursed for labor costs, placing a strain on healthcare facilities (Orangi et al., 2021). Further, even though the Linda Mama Program resulted in certain improved maternal and infant outcomes, its existence and implementation have been politicized and uncertain (Ombere, 2024).
Even though there is tremendous focus on training clinically competent midwives, evidence suggests that midwives have little impact on national policies regarding maternal health. The third global State of the World’s Midwifery report identified investment in “midwife-led improvements in service delivery” as necessary to meet sustainable development goals (Nove et al., 2