{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:10:05Z","timestamp":1758085805604,"version":"3.44.0"},"reference-count":56,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-018586"],"award-info":[{"award-number":["INV-018586"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,8]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The COVID-19 pandemic disrupted maternal healthcare access globally, leading many women to give birth outside of healthcare facilities, often assisted by traditional birth attendants (TBAs). This study explored the experiences of Kenyan women who gave birth outside of healthcare facilities during the COVID-19 pandemic based on the Person-Centered Maternity Care (PCMC) framework.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design\/setting<\/jats:title>\n                  <jats:p>This study used data from descriptive qualitative indepth interviews with Kenyan women who gave birth outside of healthcare facilities between March and November 2020. Participants lived within the catchment areas of six health facilities in Kiambu and Nairobi counties and were recruited by community leaders and community health workers. Interviews were conducted in 2020 via phone and inductively coded and analysed by a team of researchers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>A total of 28 Kenyan women who gave birth outside of healthcare facilities between March and November 2020 completed indepth interviews.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In this sample, approximately one-third of women were assisted by TBAs, while the majority were supported by friends and family members. Women generally described salient aspects of their care pertaining to the PCMC domain of supportive care. During labour, birth and the immediate postpartum, women received emotional support, basic medical assistance and instrumental support such as preparing food and baths. However, women also described concerns about giving birth outside of healthcare facilities, including poor hygiene and lack of privacy in birthing spaces as well as instances of verbal and physical harassment by TBAs. Overall, women worried about potential complications during birth, and many women delayed seeking postpartum and postnatal care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Women who were unable to access healthcare facilities during the COVID-19 pandemic relied on TBAs and\/or friends and family for support during labour and birth. These women faced gaps in PCMC, specifically related to supportive care. Given that birthing outside of healthcare facilities remains common globally, particularly during emergencies such as pandemics, TBAs should be supported to provide more person-centred care to women giving birth outside of healthcare facilities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-101458","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T02:46:16Z","timestamp":1757990776000},"page":"e101458","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Women\u2019s experiences giving birth outside of health facilities in Kenya during the COVID-19 pandemic: a qualitative study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7850-8141","authenticated-orcid":false,"given":"Rebecca","family":"Woofter","sequence":"first","affiliation":[{"name":"Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krupa","family":"Varghese","sequence":"additional","affiliation":[{"name":"Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Mboya","sequence":"additional","affiliation":[{"name":"Innovations for Poverty Action Kenya, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ginger","family":"Golub","sequence":"additional","affiliation":[{"name":"Innovations for Poverty Action Kenya, Nairobi, Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"May","family":"Sudhinaraset","sequence":"additional","affiliation":[{"name":"Community Health Sciences, University of California Los Angeles, Los Angeles, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"2025091519451192000_15.9.e101458.1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01750-1"},{"key":"2025091519451192000_15.9.e101458.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-045343","article-title":"Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review","volume":"11","author":"Moynihan","year":"2021","journal-title":"BMJ Open"},{"key":"2025091519451192000_15.9.e101458.3","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1038\/s41591-024-03103-6","article-title":"Healthcare system resilience and adaptability to pandemic disruptions in the United States","volume":"30","author":"Zhong","year":"2024","journal-title":"Nat Med"},{"key":"2025091519451192000_15.9.e101458.4","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1377\/hlthaff.2023.00720","article-title":"Disruption of non-COVID-19 health care in Latin America during the pandemic: effects on health, lessons for policy: study examines the disruption of non-COVID-19 health care in Latin America","volume":"42","author":"Bernal Lara","year":"2023","journal-title":"Health Aff (Millwood)"},{"key":"2025091519451192000_15.9.e101458.5","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.12.05046","article-title":"Continued disruptions in health care services and mental health among health care providers during the COVID-19 pandemic in five sub-Saharan African countries","volume":"12","author":"Assefa","year":"2022","journal-title":"J Glob Health"},{"key":"2025091519451192000_15.9.e101458.6","unstructured":"Newborn mortality. 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