Self-Care and Maternal Health: Building a Healthy, Equitable World for Young Women

By Sandra Mwarania, Advocacy and Program Manager at White Ribbon Alliance Kenya (WRA Kenya)

On 25 August 2019, a 20-year-old pregnant woman named Mercyline sought emergency medical treatment at a high-level public hospital in Kenya for the delivery of her twins who were due prematurely. On arrival, she was taken to the labour ward where she waited for emergency assistance from the hospital’s health workers. Unattended to, she went into labour and delivered her first baby by herself. Halfway through the second birth, she received assistance. The attending health worker assessed the condition of the newborns and told Mercyline that they were both too young to survive, then tossed the newborn twins in a cardboard box with no attempt to save their lives. Helpless and voiceless, this experience left Mercyline with deep psychological scars and a deepened mistrust of the public maternal health system. She wants other young women to know that they should never keep quiet when they are humiliated or violated while seeking maternal healthcare.

Unfortunately, Mercyline’s story is far too common among young women in Kenya, particularly those from low socioeconomic backgrounds. Their maternal health experiences are marked with disrespect and indignity, and occasionally blatant human rights violations; among those documented: non-consented care, denial of right to privacy and confidentiality, and abandonment by health workers during delivery. Women deserve quality care, and this includes an adequate number of health workers, medicines, and services to support their maternal, reproductive, and sexual health needs. WRA Kenya’s research shows that  women are beginning to redefine the type of care that they want. Between 2018 and 2019, 120,000 women and girls aged 15 – 55+ years told us that their top demand for quality maternal health services is respectful and dignified care. For women and girls, respect is simple – it boils down to how health workers speak and behave towards them. Nearly all of women’s and girls’ responses highlighted a desire to feel valued, heard and acknowledged.

“I want to be told what is happening, why is it happening, and to be asked for permission before it happens!”

When women are confident and empowered to speak up for their maternal health preferences, needs and rights, they are more likely to make better-informed health decisions for themselves, including when and how to interact with formal health systems. According to the World Health Organization, self-care is increasingly recognized as having the potential to transform health systems by equipping people with the knowledge, tools and confidence to effectively participate in health decision-making. Self-care can play an important role in improving health-related outcomes in low-resource settings with lack of or limited health infrastructure and medical services. In Kenya, advocacy organizations like WRA Kenya are working closely with young women from marginalized backgrounds to self-advocate for quality, respectful and dignified maternal healthcare in diverse contexts. We need to listen to women’s maternal health experiences and act according to their wants and needs. We also need to document and confront maternal health violence by holding health systems accountable. Cases like Mercyline’s should not be forgotten.

For health systems to work, they must work for everyone – no matter who they are, where they live, or how much money they have. Health equity is central to achieving universal health coverage (UHC), which means concerted efforts must be devoted to targeting those who are often left out of the conversation, such as adolescent and young mothers. Safe and effective self-care practices have the potential to improve the equity and efficiency of the health system by allowing each actor to maximize their contribution. Accountability structures, such as feedback channels and grievance redress mechanisms, must be formally integrated into UHC implementation processes to ensure that marginalized voices are able to engage in health decision-making. Indeed, self-care offers a path for health systems to achieve UHC. Let’s build the world we want by advocating for a supportive environment that empowers young women to trust themselves, know their rights, and take actions to improve their maternal health experiences.

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