“There is a light that our wives had not seen before”: community perspectives on a genderresponsive maternal health intervention in Western Kenya

Abstract

Background The Chamas for Change (Chamas) program is an innovative three-year community-based genderresponsive intervention in Western Kenya. During this period, the program provides peer support, microfnance initiatives, and health education to pregnant women. A randomized control trial demonstrated signifcant improvements in maternal and child health outcomes for program participants. This qualitative study explored community perceptions of the program. Methods We conducted 9 focus group discussions and 4 key informant interviews between November 2017 and June 2019. Participants (n = 75) were recruited from four sub-counties in Trans Nzoia County representing diverse rural, peri-urban, and urban settings. They included 26 pregnant women (pre-intervention), 19 Chamas women, 10 spouses, 16 CHPs, and 4 county public health nurses (post-intervention). We used purposive sampling to ensure representation across all four sub-counties where the intervention was deployed. We recruited women aged 18–45 years who had experienced pregnancy within the previous two years from each sub-county in Trans Nzoia County, capturing experiences across rural, peri-urban, and urban settings. This sampling strategy ensured comprehensive geographic representation within the intervention catchment area to understand how pregnancy experiences and gender dynamics varied across different community contexts. CHP and local leaders in each sub-county facilitated recruitment. Pre-intervention FGDs explored pregnancy experiences, gender-related barriers to care, and social support needs. Post-intervention, we examined Chamas program components, implementation, cultural acceptability, and perceived effects across individual, interpersonal, and community levels using the socio-ecological model (SEM). Data were analyzed thematically with ATLAS.ti® version 23.4, organizing fndings by SEM levels and participant type.Results Pre-intervention participants described deep-rooted gender inequities and structural barriers to care that shaped pregnancy experiences. Our analysis revealed four key themes: (1) The “heaviness” and isolation of pregnancy shaped by gender roles, (2) Building individual skills and knowledge for pregnant and parenting women and their children, (3) Enhancing interpersonal support and family dynamics, and (4) Community-wide effects and challenges of implementing a gender-responsive program. Participants reported increased self-reliance, health knowledge, and fnancial skills at the individual level. Interpersonally, the program fostered improved family dynamics, communication, and shifts in gender roles. At the community level, it enhanced social cohesion and collective action, gaining widespread acceptance due to its cultural relevance. The program’s microfnance component created participation barriers for the poorest women. Conclusion The Chamas program’s integrated approach was viewed favorably across SEM levels showing benefts for individuals and communities. Results show benefts for individuals and communities. Multiple participant perspectives provided comprehensive understanding of the program’s effect. Future research should examine modifed microfnance models to enhance accessibility for the poorest women and explore program application in similar settings. Plain English Summary Women in rural Kenya face isolation and challenges during pregnancy due to gender inequalities and limited healthcare access. The Chamas for Change program brings pregnant women together in groups that combine health promotion, fnancial savings, and peer support over three years. Researchers asked different community members - including pregnant women, their husbands, health workers, and program participants - to share their views about the program and its effects. The program empowered women in several important ways. Women gained valuable knowledge about pregnancy and childcare, learned to manage money, and developed self-reliance. The program transformed family relationships - husbands and wives communicated better, and men took more active roles in pregnancy and childcare, shifting away from traditional gender roles. Women built stronger social connections in their communities and worked together to solve problems. Community members welcomed the program and found it respected their cultural values. However, the requirement to contribute money to savings groups prevented the poorest women from participating. The researchers recommend future versions of the program should include these women and suggest testing similar programs in other communities that face similar challenges. This study demonstrates how combining health education, fnancial skills, and peer support helps address gender inequalities in maternal healthcare while respecting local culture. The Chamas for Change program shows how community-based approaches can improve maternal health outcomes and promote gender equity.