Maternity services in the context of the HIV/AIDS epidemic in Kenya

Although policies exist to promote safe motherhood in sub-Saharan Africa, maternal health has not improved, and may be deteriorating in some countries. We hypothesized that the adverse effects of HIV/AIDS on maternity services may contribute to poor maternal health. We conducted a pilot study in Kisumu, Kenya to explore: 1) how concerns related to HIV/AIDS affect uptake of maternity services and 2) the effects of HIV/AIDS on maternity workers, obstetric practices, and the quality of care. In-depth interviews with 17 health workers, 14 pregnant or postpartum women, 4 male partners, and 2 traditional birth attendants, and structured observations of 22 births, were conducted at four health facilities. Results suggest that considerations related to HIV/AIDS adversely affect both uptake and provision of maternity services. Participants reported that fears of HIV testing, involuntary disclosure of HIV status to others including spouses, and HIV/AIDS stigma are among the reasons that women avoid delivering in health facilities. HIV/AIDS also negatively affects service provision, including deaths and illness of maternity workers, increased workloads, discriminatory practices based on HIV status, and difficulties dealing with disclosure. On the positive side, health workers have received training and infection control has improved. Safe motherhood policies and programs in sub-Saharan Africa need to address the adverse effects of HIV/AIDS on use and provision of maternity services. Training of maternity workers regarding confidentiality and disclosure, HIV/AIDS stigma-reduction interventions, and addressing staffing needs could potentially improve the quality of maternity care, increase utilization, and contribute to overall improvements in maternal health.