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ABSTRACT
Maternal healthcare is a global agenda. Kenya introduced free maternity services (FMS) in 2013 to allow women to give birth for free in all government public health facilities. The introduction of FMS was timely due to the high maternal mortality rate in Kenya. FMS was also introduced to fulfil the Jubilee Party government’s elections campaign promises. It is, however, not known how primary beneficiaries and health providers perceived the FMS roll-out following the presidential directive in 2013. This article aims to explore the roles of political contestations in FMS as a social protection scheme in Kenya. In this qualitative ethnographic study in Kilifi County, we interviewed the mothers who utilised FMS and the health workers who implemented the policy. The data gathered was analysed contextually and thematically. The prevailing narrative from the health services professionals and the mothers who participated in our study is that FMS is ‘the president’s thing’ and has a clear political orientation; it is seen as deceiving the public in two ways: first by shrouding political interests, and second by adding to the burden of women, as delivery was not free – all the other services and medication before and after birth came at a cost. Health workers feel helpless and frustrated and, in most cases, they have to cope with meagre resources to ensure safe births. In some cases, quality of care is compromised due to supply-side constraints. This article shows how social protection has been used to gain political mileage and has not considered the local needs of the maternal healthcare system.
Acknowledgements
The authors would like to thank the anonymous reviewers for their insightful comments and suggestions. We are also grateful to all women and healthcare professionals who participated in this study. This article has been written as part of the Wellcome Trust-funded project ‘Reimagining Reproduction: Making Babies, Making Kin and Citizens in Africa’ (project number 222874/Z/21/Z), and we hereby acknowledge its support. Dutch Research Council-WOTRO Science supported part of this work for Global Development grant number W 08.390.006, a research project on social protection and part of the INCLUDE knowledge agenda, a platform on inclusive development policies. Fieldwork was funded by a Josephine de Karman scholarship from the University of Bern and the Nairobi-based French Institute for Research in Africa. Permission to proceed with the study and guarantee respect for human subjects was obtained from the National Commission for Science, Technology and Innovation. An introduction letter was obtained from the county health office. Ethical approval was obtained from Maseno University ethics committee (reference number MSU/DRPI/MUERC/00206/015).
Disclosure statement
No conflict of interest was declared by the authors.
Additional information
Notes on contributors
Stephen Okumu Ombere
Dr Stephen Okumu Ombere is an anthropologist. He was a PhD student in the multidisciplinary project on which this article’s data is based. He conducted an ethnographic study among the Giriama of Coastal Kenya and drafted this manuscript. Stephen is a lecturer in the department of sociology and anthropology and currently a postdoctoral fellow in the ‘Reimagining Reproduction: Making Babies, Making Kin in Africa Project’ at the Centre for Advancement of Scholarship, University of Pretoria. Stephen has published widely on the anthropology of reproduction, focusing on social protection and maternal healthcare, childbirth, midwifery, health as a common good and sexual behaviour among migrating fishermen which he continues to study and write about. He is conducting ethnographic research on women’s experiences of maternal healthcare services in Mageta Island, Western Kenya. He is also researching technology integration in higher education learning during and after Covid-19 in Kenya.
Erick Otieno Nyambedha
Prof. Erick Otieno Nyambedha is a professor of anthropology at Maseno University in Kenya. He has conducted extended research and published widely in the areas of orphans and vulnerable children due to HIV and AIDS, social protection and vaccine acceptance. He is currently conducting research on Covid-19 and universal health coverage, epi traces of medical interventions and implications for future medical practices and children in refugee contexts.
Tobias Haller
Prof. Dr Tobias Haller is a professor at the Institute of Social Anthropology. He teaches economic, ecological, and political anthropology courses at the University of Bern and the ETH in Zurich. He did research in the commons in Cameroon and Zambia. He led several large research projects on the commons, such as the African Floodplain Wetlands Project, dealing with institutional change in common pool resource management in Africa (Mali, Cameroon, Tanzania, Zambia, Botswana), commons grabbing and gender in Africa, transformation of the commons in Switzerland, the impact of mining, mega-infrastructure and conservation projects as well as the Sustainable Development Goals on the commons. Finally, he has worked on issues of food and nutrition, participatory bottom-up institution building processes (constitutionality), methods of shared research and human-predator relations (convivial constitutionality). He is a supervisor of several PhD projects on the commons in Switzerland, Norway, Mexico, Senegal and Bolivia.
Sonja Merten
Dr Sonja Merten is head of the society, gender and health unit in the department of epidemiology and public health at the Swiss Tropical and Public Health Institute in Switzerland. She has extensively conducted research on sexual and reproductive health in Africa. Her main research interests cuts across public health and other social sciences utilising both qualitative and quantitative research approaches in addressing humans’ reproductive health and wellbeing. She was the principal investigator in a multidisciplinary project funded by Dutch Research Council-WOTRO Science from which the data for this article was drawn. She supervised the main author of this article and is a supervisor of several PhD projects in Switzerland and Africa.