Kenya: To identify discrimination, we first need to get the data – health inequalities among Somali women in Mandera County, Kenya

By Claire Thomas

A recent and ongoing example of MRG’s work on health focuses on minority and indigenous women in Cambodia, Ethiopia, Kenya and Myanmar and their right to equally access sexual and reproductive health services such as contraception, pre-natal care and skilled attendance during birth. This project (funded by the UK government and run in partnership with Health Poverty Action) has three phases: first, to understand the extent to which women in minority and indigenous communities access these health services less than women nationally and why; second, to run pilot projects to tackle the barriers that are preventing women from accessing services; and, finally, to lobby for wider adoption of the successful pilot project methods so that more women benefit from these innovations. At the time of writing we are in the first phase of this project.

Some initial research focused on Mandera County in north-eastern Kenya, populated almost entirely by members of the Somali minority, has highlighted striking disparities in terms of access to essential care. Our surveys found that Somali women there were much less likely to access contraception (a shocking 1.9 per cent compared to the national rate of 58 per cent), significantly less likely to attend four ante-natal care appointments (37 per cent compared to 58 per cent nationally) and less likely to access skilled attendance at birth (39 per cent compared to 62 per cent nationally). Is it any wonder that the maternal mortality ratio in Mandera County in 2014 was 3,795 for every 100,000 live births – more than 10 times higher than the national average (362 for every 100,000 live births)?

MRG’s project has trained Somali women in Mandera to interview women within the community about why they do not or cannot access services. We believe that when Somali women themselves ask the questions, the women are more honest than they would be with an external researcher about the factors that prevent them from accessing services. Some reasons are to do with lack of provision or staffing in clinics, but some are to do with religious and cultural beliefs which women may be reluctant to discuss frankly with people from outside the community. Interviews have been carried out with 160 women and the results are being compiled. We will use this new understanding about the real barriers to accessing services, developed from within the community, to design pilot projects aiming to transform the situation.

In a linked piece of work, MRG carried out research for UNFPA on the same topic. This research analysed the data that was available globally on whether and why indigenous women access sexual and reproductive health service less than other women. We analysed 90 global surveys run by either USAID or UNICEF, which led on global health data collection. Of 90 surveys, only 8 had published data that showed whether indigenous women were able to access health services equitably. A further set of surveys had gathered that data but not published it, which we then analysed. In the end we were able to show that in the 16 cases where data existed, indigenous women were always less likely to be accessing services than the national average. This did not surprise us, but what did surprise us was the ongoing resistance to including questions about ethnicity in such surveys and publishing the findings.

MRG believes that to address a problem, you need to first collect the data and to do that you need to know which communities are benefitting from interventions or are being excluded. If you do not gather that data, or ask those questions, then you will never understand why disadvantage and discrimination are happening. And until you understand it, efforts to address it are like stabs in the dark. It is clear that, despite the fact that five years have passed since the international community committed through the 2030 Sustainable Development Agenda to ensure that ‘no one is left behind’, we all have some way to go before we can claim to have delivered on that promise.

Photo: Minority woman in Somalia / Susan Shulman