A Comprehensive Review of Maternal Healthcare in East Africa

In a detailed study exploring the responsiveness of health systems to maternal healthcare in East Africa, researchers sifted through 6,198 articles, ultimately focusing on 72 that met their criteria. This mix included quantitative, mixed-methods, and qualitative studies primarily from Ethiopia (70.8%), with additional insights from Tanzania, Kenya, and other East African nations.

Understanding Health System Responsiveness (HSR)

The review reveals varying levels of health system responsiveness (HSR) for maternity services, with ratings ranging from 45.8% to a remarkable 75.6%. Key challenges impacting responsiveness were identified, such as maternal age, urban residence, and complications during childbirth that influence the care experience. Notably, respect, non-discrimination, and patient autonomy emerged as vital components enhancing the overall quality of care.

Women’s Autonomy: A Barrier to Care?

Among the findings, it was highlighted that the percentage of women exercising autonomy in their childbirth decisions hovered between 57.9% and 66.8%. Alarmingly, many healthcare providers were reported to perform procedures without securing informed consent, which could deepen mistrust toward public healthcare services. Such neglect hampers women's rights and autonomy, igniting fears surrounding their treatment during childbirth.

Confidentiality and Dignity: Under Threat?

Confidentiality in maternity care proved inconsistent, with reports showing as few as 15% of women feeling their information was secure. Shunning of privacy due to shared spaces and inadequate hospital infrastructure further complicates women's experiences in maternity wards. Dignity was compromised as well, with reports of physical and verbal abuse, highlighting a troubling trend that urgently calls for reform.

The State of Basic Amenities and Communication

Comfortable and hygienic conditions during childbirth are paramount, yet studies indicate that only 45.8% to 65.8% of facilities provided basic amenities. Coupled with poor communication practices between healthcare workers and patients, these shortcomings create barriers to effective healthcare service utilization.

The Need for Timely Care and Social Support

Timely responses are crucial, with 62.1% to 96.3% of women getting prompt care. However, delays due to inadequate staffing and logistical challenges deter many from seeking institutional care. Additionally, the restriction of social support during labor, worsened by the pandemic, diminishes women’s overall childbirth experience.

A Call for Comprehensive Healthcare Improvements

This systematic review uncovers critical insights into how East Africa's health systems can enhance maternal care responsiveness and accessibility. Addressing these issues is essential for improving maternity service quality, ultimately reducing maternal morbidity and mortality rates. Policymakers and healthcare professionals must consider these findings to foster a more inclusive, respectful, and responsive healthcare system.

Conclusion: The Road Ahead

As this review serves as a baseline for future research, it amplifies the call for dedicated efforts to empower women, ensure dignity, and uphold rights within the birthing process. Bridging these gaps is pivotal for achieving universal health coverage and better maternal outcomes in East Africa.