Failure to Deliver: Violations of Women’s Human Rights in Kenyan Health Care Facilities FEBRUARY 4, RD AFRICA CONFERENCE ON SEXUAL HEALTH RIGHTS. ABUJA NIGERIA Claris Ogangah – FIDA Kenya Elisa Slattery - Center for Reproductive Rights

Overview Objectives Methodology of Report Findings Recommendations

Objectives of report To document barriers and abuses women in Kenya encounter when seeking/using reproductive health care services in both private and public facilities. To examine what types of mechanisms for complaints and redress are in place for women who suffer violations or abuse. To show that what is documented in report constitute serious violations of human rights in addition to having public health implications.

Methodology Gathered more than 120 women’s experiences through individual interviews, focus groups, and questionnaires, focusing on Nairobi Interviewed health care providers and administrators, licensing and regulatory bodies, and leaders of medical associations. Reviewed government guidelines, standards and manuals on RH and media coverage on RH over past 10 years. Incorporated data from 1998 and 2003 KDHS and 2004 Kenya Service Provision Assessment Survey

Abuse Around Delivery Physical and verbal abuse – –Pinched, slapped, beaten –Called “stupid,” “psycho,” told to “just die” –Cut with scissors to make delivery easier for nurses –Discrimination against younger mothers

Neglect Having to find labor ward alone Being left to deliver alone or assisted by another patient Not receiving care after delivery

Violations around stitching after delivery Having to wait extended periods of time for stitching after delivery Being stitched with insufficient or no anesthesia

Barriers to Quality Care Understaffing –Demoralized health care staff –Contributes to neglect –Can result in trainees treating women - even performing surgeries - without adequate supervision Lack of supplies/facilities –No gloves, cotton wool, anesthesia –Lack of beds, linens, wrappers for babies –Only 29% of medical facilities had all basic delivery- room infrastructure and equipment

Other Barriers to Quality Care Unhygienic conditions –Result of understaffing and lack of supplies –KSPAS – hand washing soap missing in 41% of facilities that provide delivery services –Having to deliver on soiled linens and beds Lack of record-keeping and transparency –KSPAS – only 23% of facilities conduct reviews of maternal and infant deaths or near misses –Some facilities conceal information (PMH)

Economic Discrimination User fees preventing people from seeking certain kinds of services like reproductive health check-ups Women being denied delivery services if they cannot pay deposit Inconsistent and ineffective implementation of exemptions for services Degrading and lengthy waiver process (where fee is supposed to be waived because of financial need)

Detention in health facilities for inability to pay This occurs in both public and private facilities –Women who have just delivered being kicked out of bed and forced to sleep on the floor –Having trouble getting food –Being verbally abused

Negative Effects Affect women’s future decisions about childbearing and seeking reproductive health care Deciding not to go to health care facility for next delivery Increased risk of infection for mother and baby, including HIV

Problems Complaining and Seeking Redress Lack of information about patients’ rights –Not knowing one can complain Lack of outlined procedures –Difficulties determining where one can complain or how to complain Slow or no responses to complaints Difficult getting information from government bodies –No freedom of information act although one has been drafted

Key recommendations Promote and develop policies and legislation that protect the rights of women seeking RH care and ensure sufficient oversight/regulation in both public and private facilities Remove all maternal health fees in public hospitals and allocate necessary funds to make quality maternal health care a reality Ratify Protocol on the Rights of Women in Africa, which explicitly recognizes the right to reproductive health care as key component of women’s fundamental human rights

Thank you!