Prepared by Castillo, T., Women and Children’s Program, HealthRight International, USA for International Conference on Public Health and Well-being 2019, 4-5 April, Negombo, Sri Lanka

1. Respectful Maternity Care:
Ensuring the Universal Rights of
Childbearing Women in Kenya
Theresa Castillo, EdD MA CHES
HealthRight International
International Conference on Public Health and Well-being 2019, Sri Lanka

2. What is Respectful Maternity Care (RMC)?
“RMC encompasses respect for women’s basic human rights that
includes respect for women’s autonomy, dignity, feelings,choices,
and preferences, including companionship during maternity care”
Source: White Ribbon Alliance, 2011

3. Why is RMC important?
▪ The National Human Rights Commission
received 122 complaints related to obstetric
violence from 2009 to 2012. (Mexico)
▪ 4 out of 10 women experienced the violence
and episiotomy without consent and it
happened to 1.6 million laboring women. (Italy)
▪ 62.0% of women who experienced episiotomy
were not asked for consent in the study.
(Hungary)
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4. 4
Why is RMC important?
▪The National Human Rights Commission
received 122 complaints related to obstetric
violence from 2009 to 2012. (Mexico)
▪4 out of 10 women experienced the violence
and episiotomy without consent and it happened
to 1.6 million laboring women. (Italy)
▪62.0% of women who experienced episiotomy
were not asked for consent in the study.
(Hungary)

5. Landscape
Analysis of
Disrespect &
Abuse (D&A)
Source: (Bowser and Hill 2010)
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6. RMC Charter: Universal Rights of Childbearing Women

7. Maternal
Healthcare
in Kenya:
Overview
Protective Provisions for Maternal Health in Kenya’s Constitution
✓ Article 28 Human dignity
“Every person has inherent dignity and the right to have that dignity
respected and protected.”
✓ Article 29 Freedom and security of the person
“Every person has the right to freedom and security of the person,
which includes the right not to be…subjected to any form of
violence from either public or private sources.”
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Sources: Implementing Free Maternal Health Care in Kenya: Challenges, Strategies, and
Recommendations. (Kenya National Commission on Human Rights, 2013); Failure to Deliver:
Violations of Women’s Human Rights in Kenyan Health Facilities. Center for Reproductive
Rights and Federation for Women Lawyers-Kenya, 2007.
GENERAL FACTS
▪ Maternal Mortality Rate, 2014: 510 per 100,00 live births
▪ Government establishes free maternal care services in all
public health facilities in 2013
▪ In spite of new laws, 56% of Kenyan women still choose
home births

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Kenya:
Maternal
Disrespect
& Abuse
20 %of pregnant women experience one form
of disrespect and abuse of women in healthcare
facilities:
Physical abuse, lack of informed consent, lack of confidential and
dignified care, discrimination, abandonment during care, and
detention in facilities.
(Abuya et al., 2015b)
ACCOUNTABILITY
“The Court held the Petitioner's right to maternal
healthcare had been infringed and that the abusive
actions of the nurses and the Hospital denied,
derogated and demeaned the Petitioner’s worth.”
High Court in Bungoma county (J O O v Attorney General et al., 2018)

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HealthRight RMC Projects
Partnership for Maternal and
Newborn Health Plus (PMNH+)
Imarisha Heshima
• Donor: USAID, 2012-2016
• Partners: 5 Local CBOs
• Location: Elgeyo-Marakwet
County
• Setting: 9 health facilities,
1 referral hospital
• Donor: USAID, 2018-present
• Partners: IMA World Health
• Location: Nairobi County
• Setting: 5 high-volume
health facilities

10. 10
PMNH+ (2012-2016)
Project Achievements:
• Strengthen mechanisms, health service
charter, Quality Improvement Teams,
community involvement in advocacy
• D&A stakeholders questionnaire revealed at
2014 midterm - small reductions in several
kinds of disrespect- compared to 2013
• Established County level RMC Policy in
collaboration with all local stakeholders

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Imarisha Heshima (2018 – present)
GOAL: Build the capacity of health providers, CHMTs and
sub county HMTs to deliver quality, accessible, acceptable
and dignified maternal and newborn care services
through trainings
• Obj 1 : To improve health facility provider capacity to
deliver quality reproductive, maternal & newborn care
• Obj 2 : To strengthen public health systems response to
mistreatment in birthing facilities
• Obj 3: To promote the right to safe and healthy child
birthing process at the community and household level

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What
worked well
What
didn’t work well
■ Partner presence on sites helped with
community entry and trust
■ County government support was strong
(i.e. provided facility entry letters and approval for
FGDs and KII’s)
■ Specialized services offered were
popular with client
(standard indicators e.g. delivery, ANC, PNC are high
because clients prefer referral hospitals)
■ Fully engaging all stakeholders in the
process
■ Our expertise and previous success with
RMC
■ Bureaucracy
(i.e. need for approval for to conduct FGDs , no flexibility
on training curriculums)
■ Need to streamline trainings due to costs
■ Uneven number of community health
workers assigned to catchment area
■ Harder to work with community health
workers from various community units
■ Direct referral from Level 1 to level 5
facilities was not easy

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Lessons Learned & Recommendations
1. Policy, guidelines, and standards, as well as regional
health plans must promote RMC at all levels.
2. Ensure inclusivity & ownership of this process by the
government, health workers and community
members.
3. Develop policies, strategies, and work plans that
clearly define and address disrespect and abuse.
4. Build an evidence base to document and monitor
progress.
5. Share standard reporting format with stakeholders
from the outset.
6. Work with community unit structures in and effort to
decongest public high volume facilities.

14. Thank You
Theresa Castillo, EdD MA CHES
Director, Women and Children’s Health Programs
HealthRight International
theresa.castillo@healthright.org