“The more children you have, the more praise you get from the community”: exploring the role of sociocultural context and perceptions of care on maternal and newborn health among Somali refugees in UNHCR supported camps in Kenya
Open accessAbstract
BACKGROUND: Maternal and neonatal survival are key components of population health and may be particularly vulnerable in humanitarian contexts of civil unrest and displacement. Understanding what factors contribute to poor health outcomes throughout the reproductive life cycle and across the continuum of care is crucial for improving health programming in acute and protracted refugee settings. METHODS: We undertook a mixed-methods baseline assessment of factors related to maternal and neonatal health among refugees living in the Dadaab refugee complex in eastern Kenya. The qualitative component included 23 focus group discussions with 207 community members and 22 key informant interviews with relevant UN and non-governmental organization staff, community leaders, health managers, and front-line health care providers. We analysed qualitative data for content and themes using inductive and deductive techniques. RESULTS: Taking a life course perspective, we found that the strong desire for large families and the primary social role of the woman as child bearer impacted maternal and neonatal health in the camps through preferences for early marriage, low demand for contraception, and avoidance of caesarean sections. Participants described how a strong fear of death, disability, and reduced fecundity from caesarean sections results in avoidance of the surgery, late presentation to the health facility in labour, and difficulty gaining timely informed consent. Mistrust of health service providers also played a role in this dynamic. In terms of newborn care practices, while breastfeeding is culturally supported and women increasingly accept feeding colostrum to the newborn, mixed feeding practices and application of foreign substances to the umbilicus continue to present risks to newborn health in this community. CONCLUSIONS: The findings from our study showcase the role that specific sociocultural beliefs and practices and perceptions of health care services have on maternal and neonatal health. An in-depth understanding of how these factors impact the utilization of biomedical health services provides valuable information for targeted improvements in health service provision that are tailored to the local context.
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When skin-to-skin contact was practised, its frequency varied across levels of care.
“Skin-to-skin contact was not generally reported as being practised, and when practised, its frequency varied across levels of care.28 31 36 48”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [28]
Skin-to-skin contact was not generally reported as being practised.
“Skin-to-skin contact was not generally reported as being practised, and when practised, its frequency varied across levels of care.28 31 36 48”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [28]
Studies from African countries refer to the resistance of mothers to accept skin-to-skin contact as a reason for not practising it.
“Studies from African countries refer to the resistance of mothers to accept this practice28 and lack of awareness and training of the health workers (HWs)55 as reasons for not practising it.”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [28]
Among Somali refugee women, breast feeding was practised and it was accepted to give colostrum to the baby, although mixed feeding was still practised.
“Among Somali refugee women, breast feeding was practised and it was accepted to give colostrum to the baby, although mixed feeding was still practised.28”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [28]
Umbilical cord care in the different communities was generally suboptimal, with social beliefs influencing the type of substance applied on the cord and still being common to apply foreign substances.
“Umbilical cord care in the different communities was generally suboptimal, with social beliefs influencing the type of substance applied on the cord and still being common to apply foreign substances.28 34 48 60”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [28]
Studies from African countries refer to lack of awareness and training of health workers as a reason for not practising skin-to-skin contact.
“Studies from African countries refer to the resistance of mothers to accept this practice28 and lack of awareness and training of the health workers (HWs)55 as reasons for not practising it.”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [28]
A qualitative study reported on the reasons why Somali refugee women in Kenya would not seek routine PNC consultations and mentions the inconvenience to leave the house in the early postnatal period and long waiting lines as the main reasons for not attending postnatal health checks.
“A qualitative study reported on the reasons why Somali refugee women in Kenya would not seek routine PNC consultations and mentions the inconvenience to leave the house in the early postnatal period and long waiting lines as the main reasons for not attending postnatal health checks.28”
From A systematic review of newborn health interventions in humanitarian settings (2022) · cites this paper as [28]
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- Authors
- Gee, S., Vargas, J., & Foster, A. M.
- Affiliations
- Office of the United Nations High Commissioner for Refugees (CH)
- University of Ottawa (CA)
- Corresponding author
- Gee, Stephanie
- Venue
- Conflict and Health
- Published
- 2019-03-29
- Volume
- 13
- Issue
- 1
- Pages
- 11-11
- ISSN
- 1752-1505 (ISSN-L)
- PMC
- PMC6440025
- OpenAlex
- W2942829724
- Cited by
- 22
- References
- 25
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 1
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Conflict and Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- uO Research (University of Ottawa) (submittedVersion, public-domain)
- Funders
- Bill and Melinda Gates Foundation (OPP1139645)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- maternal health, newborn health, Somali refugees, refugee camps, socio-cultural beliefs, early marriage, contraceptive use, cesarean section avoidance, informed consent, neonatal care practices, breastfeeding, colostrum feeding, life course perspective
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