The expansion of digital credit in recent years creates an urgent need to monitor the digital credit market to develop policies to improve product suitability and responsible lending. In Kenya, this expansion over the past five years has increased access to credit but also led to new consumer risks. The Competition Authority of Kenya (CAK) and IPA audited loan data from Kenya’s leading digital credit providers to inform the development of consumer protection policy strategies for the tens of millions of Kenyans who use digital credit products.
Objectives: Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors, or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use, and breastfeeding.
Design: Prospective cohort study
Setting: Health facilities in Nairobi and Kiambu counties in Kenya
Participants: Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1,014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks postpartum.
Primary and secondary outcome measures: 1) Outcomes related to satisfaction with care and care utilization, 2) Continuation of post-discharge newborn care practices such as breastfeeding.
Results: 17.6% of women reported being separated from their newborns at the facility after delivery, of whom 71.9% were separated over 10 minutes. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 minutes) were 44% less likely to be exclusively breastfeeding at 2-4 weeks (aOR=0.56, 95%CI: 0.40, 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95%CI: 1.67, 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95%CI: 1.05, 4.41), and 33% greater likelihood of exclusive breastfeeding at 10 weeks (aOR=1.33, 95%CI: 1.10, 1.62).
Conclusions: Newborns, mothers, and families have a right to high quality, respectful care, including the ability to stay together, be informed and have proper consent for care. The implications of these practices on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.
The COVID-19 pandemic disproportionately threatens vulnerable populations, including women and especially pregnant and post-partum women. Early estimates suggest that maternal and child deaths could increase by 8.7-38.6% and 9.8-44.7%, respectively, across low and middle-income countries (LMIC) due to disruptions in healthcare access and food insecurity. A global systematic review of impacts on maternal health found evidence of disruptions to healthcare services, reduced use of antenatal care, decreased access to family planning, and increased stress, anxiety, and depression related in part to isolation and fear of COVID-19 infection.3 Approximately one year into the COVID-19 pandemic, there continues to be a lack of information on the social, economic, and health impacts of the pandemic on pregnant and post-partum women and their infants, particularly from LMICs. Prior to the pandemic, Kenya, in particular, reported one of the highest rates of maternal and neonatal mortality in the world. Action-oriented research is needed to identify solutions and strategies for national and local government and communities. This policy brief provides information on the experiences of pregnant and post-partum women during COVID-19, with particular attention to healthcare access, maternal and newborn healthcare utilization, and maternal and newborn health.
Empirical social sciences rely heavily on surveys to measure human behavior. Previous studies show that such data are prone to random errors and systematic biases caused by social desirability, recall challenges, and the Hawthorne effect. Moreover, collecting high frequency survey data is often impossible, which is important for outcomes that fluctuate. Innovation in sensor technology might address these challenges. In this study, we use sensors to describe solar light adoption in Kenya and analyze the extent to which survey data are limited by systematic and random error. Sensor data reveal that households used lights for about 4 h per day. Frequent surveyor visits for a random sub-sample increased light use in the short term, but had no long-term effects. Despite large measurement errors in survey data, self-reported use does not differ from sensor measurements on average and differences are not correlated with household characteristics. However, mean-reverting measurement error stands out: households that used the light a lot tend to underreport, while households that used it little tend to overreport use. Last, general usage questions provide more accurate information than asking about each hour of the day. Sensor data can serve as a benchmark to test survey questions and seem especially useful for small-sample analyses.
BACKGROUND: Limited evidence exists on how women’s experiences of care, specifically person-centered maternity care during childbirth, influence maternal and newborn health outcomes.
OBJECTIVE: This study aimed to examine the associations between person-centered maternity care and maternal and newborn health outcomes.
STUDY DESIGN: Longitudinal data were collected with 1014 women who completed baseline at a health facility and followed up at 2 weeks and 10 weeks after birth. A validated 30-item person-centered maternity care scale was administered to postpartum women within 48 hours after childbirth. The person-centered maternity care scale has 3 subscales: dignity and respect, communication and autonomy, and supportive care. Bivariate and multivariable log Poisson regressions were used to examine the relationship between person-centered maternity care and reported maternal complications, newborn complications, postpartum depression, postpartum family planning uptake, exclusive breastfeeding, and newborn immunizations.
RESULTS: Controlling for demographic characteristics, women with high total person-centered maternity care score at baseline had significantly lower risk of reporting maternal complications (adjusted relative risk, 0.63; 95% confidence interval, 0.42−0.95), screening positive for depression (adjusted relative risk, 0.55; 95% confidence interval, 0.38−0.81), and reporting newborn complications (adjusted relative risk, 0.74; 95% confidence interval, 0.56−0.97), respectively, than women with low total person-centered maternity care scores. Women with high scores on the supportive care subscale had significantly lower risk of reporting maternal and newborn complications than women with low scores on these subscales (adjusted relative risk, 0.52 [95% confidence interval, 0.42−0.65] and 0.74 [95% confidence interval, 0.60−0.91], respectively). Significant associations were found between all 3 subscale scores and screening positive for depression. Women with high total personcentered maternity care scores were also more likely to adopt a family planning method than those with low scores (adjusted relative risk, 1.25; 95% confidence interval, 1.02−1.52). In particular, women with high scores on the communication and autonomy subscale had significantly higher odds of adopting a family planning method than women with low scores (risk ratio, 1.15; 95% confidence interval, 1.08−1.23).
CONCLUSION: Improving person-centered maternity care may improve maternal and newborn health outcomes. Specifically, improving supportive care may decrease the risk of maternal and newborn complications, whereas improving communication and autonomy may increase postpartum family planning uptake.
The Social Media Usage by Digital Finance Consumer Project is part of IPA’s Consumer Protection Research Initiative. The objective of the project is to deepen the understanding of the types of consumer protection problems experienced by digital finance consumers across three countries and types of financial providers. It consists of a social media listening tool tested on digital financial services in Kenya, Nigeria and Uganda, and will be used to inform potential further experimentation with consumer engagement and complaint handling via social media by regulators and civil society.
The digitization of financial services has been on the rise in the past years and has experienced a particularly big leap after the COVID-19 pandemic due to the temporary closure of physical offices and bank branches of many financial service providers. As financial services go digital, so do consumers by sharing their experiences, complaints and reviews through online channels and social media. Increasing use of social media channels to share feedback, concerns, and challenges provides new opportunities for insights into issues affecting digital consumers which can complement traditional methods such as phone or in-person consumer surveys.
To explore these opportunities, IPA piloted a social media listening and analysis project for consumer protection monitoring in digital financial services. This project has been developed in collaboration with Citibeats, an Ethical AI platform analyzing unstructured text. The project collects historical data on consumer protection-relevant content published on Twitter, Facebook Public Pages and Google Play Store Reviews and analyzes it using Artificial Intelligence algorithms based on Natural Language Processing and semi-supervised machine learning. The analysis provides insights into the types of consumer protection issues faced by consumers across countries and financial providers, classified into four types: 1) Commercial Banks; 2) Telecommunication companies offering mobile money services; 3) Fintech start-ups mainly offering online lending products and payment methods; and 4) Microfinance institutions.
To learn more about the methodology and main findings of this project, click the "Download" button or the PDF preview image to the right to download the full report.