“We have a lot of home deliveries” A qualitative study on the impact of COVID-19 on access to and utilization of reproductive, maternal, newborn and child health care among refugee women in urban Eastleigh, Kenya

Abstract

Background Little is known about how pregnant refugee women, and the frontline health care workers who serve them, are affected by the COVID-19 pandemic in terms of health, and health service access. Women refugees are classified as a vulnerable group with regard to pregnancy outcomes and access to maternal care, and may be disproportionally at risk for COVID-19 infection as they are likely to face unique barriers to information and access to reproductive health services during the pandemic. Few studies identify gaps that could inform potential interventions to improve service uptake for refugee women, particularly in the context of COVID-19. Yet, understanding how pregnant refugees are impacted in the context of the pandemic is critical to developing and implementing strategies and measures that can help in their care and the delivery of health services. Aims This study aimed to improve understanding of the impact of COVID-19 on women refugees’ access to and utilisation of antenatal care, delivery and postnatal care in Eastleigh, Kenya. Methods The study was conducted in Eastleigh, a semi-urban centre in Nairobi. We conducted 25 in-depth interviews with facility and community health care staff ( n = 10) and women attending antenatal ( n = 10) and postnatal care services ( n = 5) in October 2020. Data was analysed using NVIVO 12 software. Findings Our findings suggest that within the first eight months of COVID-19, preferences for home deliveries by refugee women increased and health care workers reported having observed reduced utilisation of services and delayed care. Fear, economic challenges and lack of migrant-inclusive health system policies were key factors influencing home deliveries and delayed and low uptake of facility-based care. Conclusions The findings highlight the need to mitigate and lower barriers that prevent refugee women from seeking care at health facilities. One approach includes the development of refugee-inclusive public health policies, particularly during a pandemic, and the need to tailor health care services for refugees at facilities and in the communities.

Challenges in Maternal and Child Health Services Delivery and Access during Pandemics or Public Health Disasters in Low-and Middle-Income Countries: A Systematic Review

“…Many studies suggested the need for satellite clinics to continue antenatal services during disasters. Many studies noticed unbalanced dietary patterns both in pandemics and disasters [ 16 , 17 , 18 , 19 , 20 , 27 , 35 ].…”

“…Several studies reported an increase in the number of home deliveries by traditional birth attendants (TBAs) or informal health care providers during pandemics and disasters [ 16 , 19 , 27 , 28 , 33 , 35 ]. The main reason given was that hospital accessibility was difficult due to poor road connectivity and lack of transportation services [ 16 , 19 , 28 ].…”

“…There has been an increase in non-institutional delivery due to the lack of access to health services in public health facilities. As a result, women were forced to receive benefits from private facilities at higher costs [ 27 ].…”

“…“During COVID-19, there were no maternity services in public facilities, so they opted to seek the services at the private facilities with higher cost, which was not affordable by many poor women” [ 27 ].…”

“…Another reason for increased home delivery during disease outbreaks was the risk perception of getting the healthcare staff’s infection [ 17 , 24 , 27 , 33 , 35 ]. Community members were afraid to seek treatment from healthcare facilities.…”