Trust, Care Avoidance, and Care Experiences among Kenyan Women Who Delivered during the COVID-19 Pandemic

ABSTRACT

We explore how the COVID-19 pandemic was associated with avoidance of, and challenges with, antenatal, childbirth and postpartum care among women in Kiambu and Nairobi counties, Kenya; and whether this was associated with a report of declined trust in the health system due to the pandemic. Women who delivered between March and November 2020 were invited to participate in a phone survey about their care experiences (n = 1122 respondents). We explored associations between reduced trust and care avoidance, delays and challenges with healthcare seeking, using logistic regression models adjusted for women’s characteristics. Approximately half of respondents said their trust in the health care system had declined due to COVID-19 (52.7%, n = 591). Declined trust was associated with higher likelihood of reporting barriers accessing antenatal care (aOR 1.59 [95% CI 1.24, 2.05]), avoiding care for oneself (aOR 2.26 [95% CI 1.59, 3.22]) and for one’s infant (aOR 1.77 [95% CI 1.11, 2.83]), and of feeling unsafe accessing care (aOR 1.52 [95% CI 1.19, 1.93]). Since March 2020, emergency services, routine care and immunizations were avoided most often. Primary reported reasons for avoiding care and challenges accessing care were financial barriers and problems accessing the facility. Declined trust in the health care system due to COVID-19 may have affected health care-seeking for women and their children in Kenya, which could have important implications for their health and well-being. Programs and policies should consider targeted special “catch-up” strategies that include trust-building messages and actions for women who deliver during emergencies like the COVID-19 pandemic.

KEYWORDS:

• Child health
• COVID-19
• health services
• maternal health
• trust

Acknowledgments

We express deep appreciation to the village elders and community health volunteers who assisted with recruitment of respondents, the respondents for sharing their time and insights with us, and the enumerators and team leads for their efforts, including James Opot, Nancy Onditi, and field staff: Hanna Kakuu, Nancy Wangechi, Sara Wambui, Evelyn Mukiri, Maureen Wekesa, Margaret Nyakio, Fatma Omar, Scovia Owino, Lynette Osodo, and Lily Jebet. We also thank Amanda Landrian for project assistance.

Author contributions

The overall study was conceived and designed by MS; the approach for this analysis was designed by CM and MS. Data collection was led by JM and GG. CM and MS led data analysis and interpretation, with inputs from all coauthors. CM led the drafting of this manuscript with key inputs from JM, DN, GG, MG and MS. All authors provided critical revisions to the manuscript and gave their final approval of the version to be submitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Ethical clearance was received from the Kenya Medical Research Institute (KEMRI), Scientific and Ethics Review Unit (NON-KEMRI 702) and from the University of California Institutional Review Board (IRB #20-001421).

Informed consent from participants

Verbal consent was obtained from all the study participants.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Additional information

Funding

This work was supported by the Bill and Melinda Gates Foundation (Award #INV-018586, PI: Sudhinaraset).