Jenga Mama na Mtoto – Developing Mother and Child, Faith Chebet, Northwestern University Participating Organizations: Do Right Kenya, Amref, Ampath Project dates: July 1 to August 23, 2019

Summary Jenga mama na mtoto aims to foster maternal and infant healthcare by empowering women in Kapsabet knowledge, skills, and social support. The project will promote togetherness among members of the community by creating a program through which they can identify better practices surrounding maternal health to lower the risk of maternal and infant deaths.

Background Maternal and infant mortality is one of the most effective indicators of any society’s health-welfare status. As a result, the United Nations, through the World Health Organization, monitors and evaluates these two factors. Regrettably, the postnatal period still remains the most neglected aspect of maternal care globally, with about 830 women dying every day from pregnancy and childbirth-related complications. The current maternal mortality rate (MMR) is highest in sub-Saharan Africa and accounts for 62% of all global maternal deaths. In 2015, Kenya ranked among the top ten in maternal deaths by the UN, reporting an average MMR of 580 out of 100,000 live births. The leading areas in maternal and infant mortality rates in Kenya are the Northeastern, Western and slum areas. Kapsabet is an area located in , in Rift Valley. It is one of the poorest in the county. As expected, the MMR in this sublocation is also among the highest in the country. Most of the deaths that occur among women are a result of causes directly related to pregnancy and childbirth. Most of the women in Kapsabet prefer home births to hospital or clinic births. The government claims that 80% of healthcare facilities in Kenya offer the full spectrum of maternal care, including postnatal care, but only about 30% of women in rural Kenya, including Kapsabet, deliver in a healthcare facility. Due to the high rate of home deliveries, traditional birth attendants (TBAs) are the pillars of the maternal health sector in Kapsabet, conducting delivery services and advising on infant and personal care. These practices are deeply rooted in the lives of many women in Kapsabet, and the strong relationships developed between the women and their TBAs contributes to a low use of biomedical services. Most TBAs are experienced in birth delivery but have little information about modern biomedicine, due, in part, to low literary rates. Consequently, safe motherhood initiatives, such as the provision of free maternity services, are still being underused by many women in Kapsabet while some potentially harmful traditions, like using cow dung and soil for cord care, are still practiced. My project will use an ethnographic approach to examine the close relationships between mothers, TBAs, and community health workers. I will learn the motivations and cultural structures that facilitate traditional healthcare to better understand how to promote clinical healthcare and develop a program that fosters collaboration in working towards the common goal of improved maternal and natal care. I will implement my project in four villages: three villages in Kapsabet--Chepterit, Chepkunyuk and Namgoi--and one in . These villages were selected because of their low socio-economic status and high maternal and infant mortality rates. The latter location has already benefited from Do Right Kenya’s efforts to encourage more mothers to access health services in clinical settings and will therefore serve as a point of comparison. Efforts to address maternal morbidity and mortality will rely upon collaboration with a county maternal health coordinator, a head superintendent in maternal health, two community workers from each of the four mentioned villages, two representatives from Do Right Kenya and two other NGOs, Ampath and Amref.

Timeline July 1 to July 6: I will meet with representatives from the above NGOs to better understand Kenya’s maternal health.

July 8 to August 9: I will interview stakeholders about cultural traditions and modern biomedical structures in maternal and infant health in Kapsabet. I will contact women through referrals from Do Right and Ampath. Privacy and confidentiality will be upheld throughout the project. My interviews will include specific but open-ended questions to learn about the experiences and perspectives of these women regarding maternal and infant health services during and after delivery. One half will be mothers who have sought modern medical care and the other half will be mothers who have only experienced traditional medical services. I will ask them questions about their pregnancy, antenatal care, institutional delivery versus home delivery, and recovery periods. Meanwhile, I will hold separate discussions with TBAs. During the last three days of each week, I will conduct visits to local clinics and the district hospital through invitation from the superintendent of the county hospital. Under the supervision of the maternal county health official, I will interview the community health workers and experience direct observation of the day-to-day activities in the maternal wards. During the fifth week, I will work in Isiolo, a village that has had tremendous influence from Western maternal medical care through Do Right. This experience will enable me to develop comparative insights of traditional versus modern maternal health care and how they can possibly work together instead of being a choice between one over the other.

August 12 to August 23: During this period, I will work with the county health maternal coordinator and the head superintendent in maternal health in translating what I have learned. I will then share the report with the TBAs, community health workers and the NGOs. The next week will involve two-day workshop sessions in each of the four villages discussing what I learned, and most importantly how to bridge traditional and biomedical services. With the permission of local church leaders, I will hold our forums in the churches so that the community will be more receptive to the program. The discussion will be initiated by community health workers and TBAs according to a predetermined plan. We will then have a community dialogue that involves small groups for the community members to share their experiences, perceived challenges and possible ways to move forward. Afterwards, we will reunite and complete the forum with a new proposal based on the report, including the collaboration of the TBAs, the county district hospital, local clinics and the women. During each meeting, I will be a moderator and a notetaker. As an incentive and an appreciation to all who attended, I will give all the participants a care package at the end of the last session, containing such essential items as maize flour, sanitary towels, contraceptive tools, and soap. Also, I will supply the TBAs with affordable prepaid phones to contact the clinical health community workers during emergencies.

Sustainability Most women in Kapsabet belong to small groups called chamas, which they use for loan programs. During the final information session, I will encourage them to include discussions around maternal and infant care during these meetings. I will distribute information pamphlets with helpful diagrams and instructions on maternal and infant health. To facilitate effective and fast communication between the TBAs and the health workers, I will provide prepaid mobile phones to TBAs. This step is necessary because medical emergency networks in Kenya are not efficient--usually takes hours for the authority to respond to emergencies especially in rural areas.

Qualifications During my internship period with Do Right, an NGO that focuses on reducing infant and maternal mortality rate, I began to understand that complex social, cultural, and structural determinants shape the prevalence of home deliveries and the disconnect between available medical services and rural communities. I was also able to work with some of these women in clinics and health facilities and gained some quality ethnographic experience. I lived in Kapsabet for eight years, and I am fluent in Swahili, Kenya’s national language, and Kalenjin, which is the community tribal language in Kapsabet.