Title: Maternal Mortality in East Africa
Funder: Medical Research Council

Abstract: This partnership brings together researchers from the Arts and Humanities - history, historical and medical anthropology, linguistics and theatre studies - with medical and public health specialists, to address a key global health development challenge: extremely high Maternal Mortality Ratios (MMRs). It will focus on western Kenya, but seek to influence policy and practice across East Africa. While Kenya's crude death rate is now on a par with Europe, its MMR was 510/100,000 livebirths in 2015, 43 times higher than high-income regions. On current trajectories, Kenya, like most African countries, will not come close to the Sustainable Development Goal (SDG) MMR target of 70/100,000 by 2030. Our partnership seeks to develop new approaches to maternal health through interdisciplinary research and networking. Drawing on and further developing established relationships between East African and European arts and humanities and medical researchers, this medical humanities partnership will be based on the principles of international collaboration and co-production, motivated by the goal of reducing excessive maternal mortality. Our broader aim is to establish a regional consensus that socio-cultural research can effectively address major health problems. That high MMRs are a particularly important, intractable health problem has been acknowledged both within the UK government, which has made working 'to end preventable child and maternal deaths' one its seven aid priorities, and in Kenya's national plan (Kenya Vision 2030), which identified MMRs as one of two key areas 'where Kenya is lagging'. Kenyan partners in government, medical institutions and key NGOs recognise high MMRs as a national priority, acknowledge that risk factors remain poorly understood, have informed the definition of problems which this partnership seeks to addressed, and are prepared to engage in research, policy development, and implementation. This partnership's approach has developed from medical researchers' recognition that high MMRs result not only from physiological problems and infrastructural deficit, but also relate to patients' experience of biomedical maternity services, domestic decisionmaking, social norms and collective understandings of motherhood, health and illness. Arts and Humanities researchers will work with medical practitioners, policymakers and teaching staff to consider in particular how, in both domestic and clinical settings, risk is evaluated, information is communicated, and resources are allocated. Research will focus on the western Kenyan region around Kisumu, investigating why recent interventions, such as free maternity services and building referral hospitals, have had less impact in Kenya than anticipated. The partnership will consider why some interventions, effective in other countries, have proven problematic within the Kenyan context, and also compare Kenya's past successes in maternal healthcare with the relative stagnation of recent decades. Researchers will utilize a range of methodologies, including archival research, interviews, linguistic analysis and participatory theatre. They aim to better understand the tensions and miscommunication which often characterise clinicians' relationships with pregnant women, and the unintended consequences of policy changes. They will also investigate the gender and generational factors which shape health-related decisionmaking within the household, peer-groups, and extended family. Throughout, our partnership will be shaped by co-production with African academics, practitioners and institutions, building capacity in north the Global North and South. This will assist communication of findings to government, hospital administrations, citizens and NGOs such as INDEPTH, WHO, and Unicef. Outcomes will be shared with policymakers across the East African region, and a range of tools, music, radio and theatre will be used to communicate key messages across the Kisumu region.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH