Respectful maternal care and by who? perspectives of Somali community at IFO refugee Camp, Dadaab, Kenya

Respectful maternity care is where women are accorded the freedom to make informed choices, protects them from any form of harm and harassment, provides continuous support during labour and child birth and also upholds their privacy, confidentiality and dignity. Previous studies have demonstrated that any care deemed to disrespect the woman may henceforth determine her care seeking behaviour. In the lacuna created by some forms of disrespect of women of child bearing age in the healthcare system, some women may seek alternative care from traditional birth attendants, who are neither skilled nor able to promptly recognize, manage or refer complications arising during pregnancy, labour, child birth and puerperium. Globally, the high maternal mortality rate is associated with preventable complications which occur during pregnancy, labour, child birth and the puerperium, with those who encounter near misses or who narrowly survive death, end up suffering lifelong disability which affects their quality of life. Services offered by traditional birth attendants (TBAs) continue to be sort by a few women of reproductive age in both rural and urban settings including Dadaab, despite the availability of both public and private health facilities. TBAs are preferred among the Somali community as they are deemed to offer a type of care that is regarded as being respectable to the woman and her family as well as being aligned to their culture and religion. Hence, this study aimed to investigate the perspectives of the Somali community residing in Dadaab refugee camps on respectful maternal care. A qualitative study was conducted at Ifo refugee camp in Dadaab, where three TBAs, two save mothers, two married men and two expectant women were interviewed. Two focused group discussions were conducted among the men and pregnant women. The TBAs and the save mothers were interviewed. The TBAs were also video recorded as they performed some of their activities. Data was coded, categorized into thematic areas and the content was analyzed. The findings demonstrated that TBAs and save mothers accorded the women both social and psychological support during pregnancy, child birth, and postnatal period, and treated them with respect. They accompanied the mother throughout the labour and childbirth and gave her so much encouragement. The findings further revealed that cultural beliefs and practices such as prayer, disposal of the placenta and the gender of the care provider, play a big role in maternal care of the women. The placenta is valued as a significant part of the woman’s body and thus has to be buried according to their culture, as opposed to it being disposed of after giving birth in a health facility. Respectful maternal care should be accorded to all women irrespective of their background and should also be culturally sensitive