'Our voices matter' : the role of individuals, families and communities in creating and driving demand for maternal health services

Abstract

Popularizing Summary This doctoral research was conducted between 2013 - 2015 in Kwale county, Kenya so as to understand the cultural beliefs, traditions and practices of the Digo, the main community living there, and how these could influence whether or not they take up and use interventions aimed at improving the health of women. It was aimed at describing how the community is structured in terms of the place of women in society, who makes decisions around the health of women, the role of religion in determining the health of women and how all these may have changed over time. This was meant to describe the context under which maternal health programs in this setting were being implemented. The main approach to this research involved participating in their day-to-day activities so as to better understand their way of life and how this had changed over time as well as conducting interviews and having group discussions with various community members, community ‘gatekeepers’, local administrators, key opinion leaders, local health providers as well as other local stakeholders. The study also designed and tested an intervention that actively involved the community in making decisions to improve the health and well-being of women. This was implemented through structured community meetings that sought to create awareness of the benefits of using family planning methods and giving birth under the supervision of a skilled health provider. The meetings allowed community members to identify local issues that promoted or discouraged use of these services then create a specific plan of action to encourage more women in the community to use these services. They also tracked the implementation and outcome of these plans of action. To determine whether this intervention had improved the use of family planning methods and increased the number of women giving birth under the supervision of skilled providers, we compared the number of women who had used these services before and after our intervention. We also interviewed individual women in their households regarding their current use of family planning methods as well as their most recent place of giving birth. This assessment showed a significant increase in the use of family planning methods and the number of health facility births. Findings from this study also showed that among the Digo, specific standards related to their predominant Islamic religion as well as widely held beliefs about the place of men versus women in the society, were an important influence on whether women ultimately used family planning methods and/or delivered under the supervision of a skilled health provider. Specifically, we found that a prominent mother-figure in the community played an important role in deciding whether or not women gave birth in a health facility or used family planning methods. The findings from this doctoral research highlight the importance of implementing public health programs by responding to the unique way of life of targeted communities. They illustrate the success that such programs could achieve when they actively involve individuals, families and communities targeted by their interventions. These findings are important for policy makers, public health practitioners and researchers in similar setting to enable them to understand the context within which they are working and to actively involve individuals, families and communities in order to have effective outcomes. Most importantly, the findings underscore the need to be sensitive to the local way of life and address unique factors that either prevent or promote uptake of public health services so as to remain relevant and sustainable over time