Research Spotlight: Perceptions of Care in Migori County, Kenya

Childbirth experiences: Community perceptions of care in Migori County, Kenya

Why aren’t more women in sub-Saharan Africa using maternal health services?

Several studies have suggested that women in sub-Saharan Africa have negative views about the quality of maternal care available during childbirth, and therefore are less likely to access maternal health services during pregnancy or labor. However, very little is known about why there are poor perceptions of maternal health services, what factors contribute to those opinions, and who is most likely to have these views.

Dr. Patience Afulani, a postdoctoral fellow with the Preterm Birth Initiative, has created a survey tool to better understand community perceptions of quality of care during childbirth. So far, her team has conducted over 1000 interviews in Migori County, Kenya, to better understand and document women's childbirth experiences in different health facilities. Migori County is a rural region in Western Kenya that serves as the primary site of PTBi East Africa's work in Kenya.

The survey evaluates the childbirth experience in health facilities across 10 different patient-centered areas: dignity, autonomy, privacy/confidentiality, communication, supportive care, social support, trust, stigma and discrimination, transparency and predictability of payments, and health facility environments. Survey items range from more subtle indicators of poor care — such as providers not introducing themselves to the women — to overt verbal and physical abuse.

Kenyan women were asked questions about their childbirth experiences: 

Did the doctors, nurses, or other staff at the facility treat you with respect?

Did they ask your permission/consent before doing procedures on you?

Dr. Afulani’s team is also interviewing family members and health care providers, to obtain in-depth information about the quality of the childbirth experience and to identify factors contributing to poorer quality care. This includes collecting data to help understand how elements such as education or wealth can create disparities in women’s experiences.

This scale will be an invaluable tool for addressing the person-centered dimensions of quality care during childbirth. The findings of this study can inform quality improvement efforts to enhance women’s experiences during childbirth, both in sub-Saharan Africa and beyond.


Dr. Patience Afulani, MBChB, PhD, MPH, is a postdoctoral fellow with the Preterm Birth Initiative in the Department of Obstetrics, Gynecology & Reproductive Sciences at UCSF.