According to the World Health Organization, every 8 minutes a woman in a developing nation will die of complications arising from an unsafe abortion. (WHO) 99% of all maternal deaths occur in developing countries. Now the question is, why is this happening and can we prevent this? This is something I’ve always wondered. Why isn’t there a larger focus on Reproductive Health as a Public Health issue? So many developing countries as facing many issues with reproductive health that could be resolved. This is a topic I’ve always found myself very passionate about and wanted to solve. That is why I decided to focus on Reproductive Health Access in Kenya for the duration of this class. I found that the theoretical model Critical Medical Anthropological Theory fit the issues in Reproductive Health Access in Kenya the best. Kenya faces many factors towards this issue such as political, social, cultural, and economic determinants. Kenya faces poverty and political turmoil but is also a country with a rich culture that has protected that cultural for many years. That is why I found Kenya so interesting to research because it faces so many factors that we may not face in the United States.
The first part of this discussion I want to address is what Critical Medical Anthropological Theory actually is since it applies so much to Reproductive Health Access in Kenya. The following is a quote from week one’s lecture, “ The big question of critical medical anthropology: Who benefits and who suffers? And just remember, that diseases and health issues are more political and economic and social than we usually think they are. “ This theory specifically looks at how these assumptions and behaviors by people who have power impact the health of people without power. Political and social determinants play critical roles in reproductive health care access for women in Kenya as they face a lot of negative stigma and political disadvantage as they are laws prohibiting certain family planning methods. This can be better explained with Structural violence. Structural violence is when social arrangements put individuals and populations in harm’s way. An example of a social arrangements that puts women in harm’s way when it involves reproductive health care access is Kenya’s strict abortion laws. Since women in Kenya do not have the right to recieve legal medical abortions, many women turn to unsafe abortions which in turn in more harmful. Unsafe abortion is the leading cause of maternal deaths in developing countries. In an article by structural violence.org, they discussed how structural violence manifests in obvious forms such as dying from preventable diseases, “One such study, in 2009, concluded that more than 60 million extra Americans would be alive — that is, 60 million Americans died prematurely — due to the shorter life expectancies visited upon those of us in the United States.” ( StructuralViolence.org ) If we can trace back on these structural violence and acknowledge them, we can work towards fixing them.
So, if we look at something as simple as statistics, we can try and figure out possible causes. In Kenya, 46% of their people live below the poverty line. (UNICEF) Majority of the population is susceptible to economic and social shocks because of this. Their people face struggles with access to basic services such as health care, education, clean water and sanitation. Using this theory we have to ask why? What is causing this?
Well, there are many factors including social, cultural, political, and economic determinants facing Kenyans. While in the United States we may not face all of these at such high degrees, Kenya does. To start off, I am going to discuss the social determinants facing Kenyans. According to Healthypeople.gov, some social determinants include Transportation, Public Safety, Access to health services, Exposure to crime, violence, and social disorder, Access to educational, economic, and job opportunities, and Availability of resources to meet daily needs. In Kenya, the percentage of male enrollment for Secondary education is 51.6%, and even less for females at 48.4%. (UNICEF) That means half of Kenya’s youth is not getting through past a standard high school education. Not having an education means less job opportunities and higher risks for poverty. The percentage of the poorest 20% in Kenya who have a Skilled attendant at birth is 20.3% and The percentage of the richest 20% in Kenya who have skilled attendant at birth is 81.4%. ( UNICEF) Obviously, we can see how access to job opportunities, education, and poverty link together and cause a greater issue in Reproductive health access in Kenya. Access to transportation is also a major issue in Kenya. The issue Kenya faces with transportation is between city and rural areas. Kenyans face difficulties accessing clinical care as it is offered in larger cities and rural areas have no access to transportation to get there. Lack of transportation can have a significant impact on health and on the ability to make healthy lifestyle choices, such as regular physical activity, access to healthcare, access to steady, well-paying jobs, and ability to purchase healthy foods. (ASTHO) When it comes to Reproductive Healthcare access, women lack the resources to be able to travel to hospitals and clinics. When complications happen when giving birth in rural communities, it is difficult to transfer women to hospitals in a timely manner. This is the main social determinant I found most prominent. As Kenya tries to better access to these services by making maternal care free, many women cannot access them as these services are in cities. It makes it extremely difficult for them when emergencies during childbirth happen as well. If they have no access to transportation, it can be discouraging to access services but also life threatening.
Continuing on, many people do know how rich the culture in Kenya is. Culture can really affect health in major ways. In Kenya many young girls face Female Genitial Mutilation. 21% of women will experience female genitial mutilation in Kenya. In Kenyan culture, this may be a rite of passage for many as a woman and has been apart of Kenyan culture for many years. But, it ruins a woman’s chance of an education, as many are married off and can never return back to school. This ruins a woman’s life forever. Not only is she being physically tormented, she is being forced in a child marriage most of the time, raped, and forced into bearing child pregnancies. Culture can add other barriers to health. Culture also contributes to social determinents as show by example in FGM.
Another cultural factor is in childbirth, most of Kenyan women prefer childbirth at home by help of traditional birth attendants compared to childbirth in the hospitals by help of trained health workers. In Busia, Kenya, fathers insist that their wives conduct childbirth at home because they believe newborns are supposed to stay indoors for up to four days for a boy and three days for a girl until they are named to avoid bad omen. This is also to insure that the placenta is safely buried to avoid someone stealing it and bewitching the baby.(Nanjala, 2012)
Another example is in Homabay and Migori Districts, Kenya, women are supposed to remain at home during the period after delivery. They believe that the period of seclusion is to protect the newborn from “evil spirits” or people who might try to bewitch the baby (FCI, 2003). This practice may affect the demand of the necessary health care for the mother and/or child.
The political world in the country of Kenya is very tense right now. Their government is facing major corruption which puts its citizens at risk. According to Human Rights Watch, human rights organizations and those critical of the government face threats and restrictions, including on freedom to assemble. Officials reportedly have targeted activists and victims of police brutality. They faced threats of arrest, warnings not to post information on the internet about police brutality during the elections period, home and office raids, and confiscation of laptops and other equipment. Many women have reported being raped as well.
These all are examples of structural violence as explained in Critical Medical Anthropological Theory. In Kenya, they punish consensual same-sex relations with up to 14 years in prison.( Human Rights Watch ) As well as Abortion is illegeal unless absolutely medically necessary. Which leads to unsafe abortions across the country. All of this leads Kenyan women to not trust government healthcare providers. It also does not allow LGBTQ+ citizens to willingly access reproductive health services in fear of getting into trouble.
With an uneasy political atmosphere, it is hard for people to trust the things the government does do for them. It also can put people in deeper poverty and danger. Especially when trying to seek out care after completing something such as an unsafe abortion or relations with the same sex since both of these things are illegeal in Kenya.
Lastly, the economy is a major factor for Kenya. Kenya has steady growth in an incoming middle class. But, according to the CIA its economic development has been impaired by weak governance and corruption Unemployment and under-employment are extremely high, and could be nearly 40% of the population. ( CIA) International funds are a key part of Kenya’s growth and development. But, it is not something they can always rely on and can be a major problem for them in the future.
Now, how does this all directly relate the issue of Reproductive Health Access in Kenya? Well, all of these determinants have a key part of why this is a health issue. They correlate with each other as well. Because of the high employment rates and poverty, many cannot afford to access health care. Family planning methods are not even a thought because of the costs and availability of them. As well as the culture in Kenya may lead women to steer away from accessing care during childbirth. The main issue for Reproductive Health Access is the social determinants. Women can easily access transportation to receive these health services. They also do not receive education about family planning methods, ways to access these services, and how to protect themselves. If there were more possibilities to educate these women, they’d have better outcomes. As well as the culture in Kenya can prevent women from accessing safer child birthing methods or cause physical disturbances that impact women physically and mentally. There is also a political climate that may prevent women for sticking up for themselves and asking for better care. With a corrupted government, you never know who to trust. But overall, there are so many factors affecting reproductive health access in Kenya.
Overall, there is a lot of determinants in Reproductive Health Access in Kenya. Critical Medical Anthropological theory helps us to understand why some of these things are taking place in Kenya. We also can better understand by looking at these determinants. When we find our whys, we are better able to understand what we can do to better improve health outcomes for these women. I really liked being able to look at it from this perspective because we were able to trace back like an epidemiologist would with an epidemic. I believe we could continue to use this idea on other public health issues. Especially with reproductive health access. There is so much working against women in Kenya. If we backtracked and tried to fix even a few of these issues, we would be able to better off the health of so many women. While some issues take time and work, such as political disturbances and cultural expectations, other things such as transportation or even sterile supplies for midwives to use during childbirth in their villages. There are so many options for us to make an impact and try to help the issue. If we really tried and made that effort, any impact would be a major impact on Reproductive Health Care access in Kenya.
“Preventing Unsafe Abortion.” The World Health Organization. Accessed August 16, 2019. https://www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion.
“Overview.” UNICEF Worldwide. Accessed August 16, 2019. https://www.unicef.org/kenya/overview_4616.html.
“Maternal Mortality.” The World Health Organization. Accessed August 16, 2019. https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality.
“Social Determinants of Health.” Social Determinants of Health | Healthy People 2020. Accessed August 16, 2019. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.
“World Report 2019: Rights Trends in Kenya.” Human Rights Watch. January 17, 2019. Accessed August 16, 2019. https://www.hrw.org/world-report/2019/country-chapters/kenya.
“The World Factbook: Kenya.” Central Intelligence Agency. February 01, 2018. Accessed August 16, 2019. https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html.
“Global Database on Violence against Women.” Kenya. Accessed August 16, 2019. http://evaw-global-database.unwomen.org/fr/countries/africa/kenya.