Program for Psychosocial Assessment During Pregnancy: Protocol for a Multimethod Study.

Rwanda makes health-facility deliveries more feasible

Background In the recent past, the number of forcibly displaced people increased worldwide. About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women who are coming to Germany are currently of childbearing age. Refugee women are considered a highly vulnerable refugee subgroup, as they frequently experience physical strains and psychological burdens while fleeing their home countries and being pregnant at the same time. Moreover, pregnancy and the following period require specialized care and support in order to allow a transition to maternity without complications. The aim of this project is to analyze maternal health care services for refugee women on the level of interaction with maternal health care professionals in Germany. Methods Maternal health care professionals in outpatient and clinical settings with experiences of caring for refugee women were recruited. Semi-structured interviews were conducted. The interviews were analyzed following the standards of qualitative thematic analysis. Results Maternal health care professionals face challenges in implementing and providing maternal health care concerning their professional practices and interventions. Due to a lack of resources (e.g. translators, time) and other conditions, gynaecologists and midwives are forced to find new solutions that maintain (medical care), adapt (vaginal examination) or miss out on (informed consent) ordinary professional practices. Key messages Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers and problems in relationship building. The identification of challenges and opportunities for professionals in maternal health care provision may contribute to improve maternal health (care) for refugee women.

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care.

Background The number migrants increased worldwide. Pregnant migrant/refugee women are considered a vulnerable group. How do professionals manage their care? The aim was to summarize the current evidence regarding maternal health care provision for migrant/refugee women. Methods We conducted a systematic review and searched the databases PubMed (MEDLINE); CINAHL; PSYNDEX, PsycINFO and Cochrane Library. Studies were judged for eligibility: a study had to address maternal health care provision for migrant/refugee women who immigrated to an OECD member state. Publication date was restricted to 1990-2019, and language to English or German. Results 16 primary (qualitative) studies were included. Heterogeneity of the included studies exists regarding e.g. origin of the women, migration background, receiving country. Nevertheless, synthesis can provide valuable information on challenges and how to deal with migrant/refugee women in maternal health care. Communication difficulties pose challenges on professionals (15 studies). Possibilities to deal with them: bridge-languages, non-verbal communication and interpreters. In addition, finding one's way in the unknown health care system is a barrier for women, which professionals can meet by informing the women and coordinating care (8 studies). The perceived diversity of women can lead to conflicts in care (10 studies). While some studies recommend 'cultural recipes', other authors emphasize the individuality of women and prefer a holistic care approach. Conclusions Professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for professionals that convey general principles such as woman-centered care, communication techniques are valuable opportunities to improve migrant/refugee women's maternal health care provision. Key messages Maternal health care professionals face different barriers when providing maternal health care to migrant/refugee such as communication barriers, coordinating care and handling women's diversity. Initiating and enhancing public health activities such as training courses for maternal health care professionals are valuable opportunities to improve migrant/refugee women’s maternal care.

Balancing it out: the process by which midwifery students provide care to women following stillbirth in Papua New Guinea

The study assesses the degree and patterns of horizontal inequity in maternal and child health care utilization in Nigeria. Horizontal inequity was estimated using concentration curves and a standardized concentration index, which was decomposed into need and non‐need variables to capture the major drivers of inequity in utilization. Maternal and child health care utilization was measured by antenatal visits, skilled delivery and immunization utilization. Four rounds of Nigerian Demographic and Health Survey (DHS) data (1999, 2003, 2008, 2013) were used. The results show a positive horizontal inequity index from 1999 to 2013; which indicates that there is pro‐rich inequity in utilization of antenatal, skilled delivery and immunization, respectively. The study concludes that there is higher and increasing inequity in maternal health care while inequity in utilization of child health care decreased over time with wealth status and education as the major non‐need drivers of inequity in utilization. Interventions to enhance women's wealth status and education could significantly improve equity in skilled delivery and antenatal care utilization. Hence wealth creation, women empowerment and education should be given more attention to improve the deteriorating equity in maternal health care utilization.

BackgroundThe Taliban takeover in August 2021 brought global economic sanctions, economic collapse, and draconian restrictions on women’s freedom of movement, work, political participation, and education. This study examined Afghan health workers’ experiences and perceptions of availability and quality of maternal and child health care since then.MethodsWe conducted a survey, using a convenience sample, of health workers from urban, semi-rural, and rural public and private clinics and hospitals across the 34 provinces, covering changes in working conditions, safety, health care access and quality, maternal and infant mortality as well as perceptions about the future of maternal and child health and health care. Interviews were conducted with a subsample of health workers to further explore their perceptions of changes in working conditions, quality of care, and health outcomes since the Taliban takeover.Results131 Afghan practicing health care workers completed the survey. The majority were women (80%) working in facilities located in urban areas. Most female health workers (73.3%) reported that they have not always been safe when going to and from work; 81% because of harassment by the Taliban when they did not have male accompaniment. Almost half of the respondents (42.9%) reported a decrease in availability of maternal and child care and 43.8% stated that conditions for providing care were “worse” or “much worse” than before. Almost one-third (30.2%) indicated that changed working conditions negatively impacted their ability to provide quality care, and 26.2% reported an increase in obstetric and newborn complications. Health workers also reported (38.1% )an increase in sick child needs and an increase in child malnutrition (57.1%0. 57.1% reported decreases in work attendance and 78.6% a decrease in morale and motivation. Qualitative interviews (n = 10) of a subsample of survey participants expanded on these findings.ConclusionThe combination of economic collapse, lack of sustained donor support for health care and Taliban interference with human rights has severely compromised access and quality of maternal and child health care. Strong and concerted international pressure on the Taliban to respect women and children rights to essential health service is critical for the future of the Afghan population.

This webinar focuses on strategies for implementing evidence-based practices that will make a real difference to improving maternal and neonatal health, which ties in closely with SDG targets 3.1 and 3.2 in particular. We invite you to read related content in the collection on [Implementation of Evidence-Based Practices for Improving Maternal and Neonatal Health](https://www.biomedcentral.com/collections/IEBP), published in [Implementation Science](https://implementationscience.biomedcentral.com/) and [Implementation Science Communications](https://implementationsciencecomms.biomedcentral.com/). The Guest Editors of the collection - Michelle H. Moniz, Rebecca Hamm, and Jennifer Callaghan Koru - are chairing the event, with the Springer Nature SDG3 chair, Fiona Pring, introducing the event. Implementation research priorities for addressing the maternal health crisis in the USA: results from a modified Delphi study among researchers Background: Maternal health outcomes in the USA are far worse than in peer nations. Increasing implementation research in maternity care is critical to addressing quality gaps and unwarranted variations in care. Implementation research priorities have not yet been defined or well represented in the plans for maternal health research investments in the USA. Methods: This descriptive study used a modified Delphi method to solicit and rank research priorities at the intersection of implementation science and maternal health through two sequential web-based surveys. A purposeful, yet broad sample of researchers with relevant subject matter knowledge was identified through searches of published articles and grant databases. The surveys addressed five implementation research areas in maternal health: (1) practices to prioritize for broader implementation, (2) practices to prioritize for de-implementation, (3) research questions about implementation determinants, (4) research questions about implementation strategies, and (5) research questions about methods/measures. Results: Of 160 eligible researchers, 82 (51.2%) agreed to participate. Participants were predominantly female (90%) and White (75%). Sixty completed at least one of two surveys. The practices that participants prioritized for broader implementation were improved postpartum care, perinatal and postpartum mood disorder screening and management, and standardized management of hypertensive disorders of pregnancy. For de-implementation, practices believed to be most impactful if removed from or reduced in maternity care were cesarean delivery for low-risk patients and routine discontinuation of all psychiatric medications during pregnancy. The top methodological priorities of participants were improving the extent to which implementation science frameworks and measures address equity and developing approaches for involving patients in implementation research. Conclusions: Through a web-based Delphi exercise, we identified implementation research priorities that researchers consider to have the greatest potential to improve the quality of maternity care in the USA. This study also demonstrates the feasibility of using modified Delphi approaches to engage researchers in setting implementation research priorities within a clinical area. Group prenatal care successes, challenges, and frameworks for scaling up: a case study in adopting health care innovations Background Group prenatal care enhances quality of care, improves outcomes, and lowers costs. However, this healthcare innovation is not widely available. Using a case-study approach, our objectives were to (1) examine organizational characteristics that support implementation of Expect With Me group prenatal care and (2) identify key factors influencing adoption and sustainability. Methods We studied five clinical sites implementing group prenatal care, collecting qualitative data including focus group discussions with clinicians (n = 4 focus groups, 41 clinicians), key informant interviews (n = 9), and administrative data. We utilized a comparative qualitative case-study approach to characterize clinical sites and explain organizational traits that fostered implementation success. We characterized adopting and non-adopting (unable to sustain group prenatal care) sites in terms of fit for five criteria specified in the Framework for Transformational Change: (1) impetus to transform, (2) leadership commitment to quality, (3) improvement initiatives that engage staff, (4) alignment to achieve organization-wide goals, and (5) integration. Results Two sites were classified as adopters and three as non-adopters based on duration, frequency, and consistency of group prenatal care implementation. Adopters had better fit with the five criteria for transformational change. Adopting organizations were more successful implementing group prenatal care due to alignment between organizational goals and resources, dedicated healthcare providers coordinating group care, space for group prenatal care sessions, and strong commitment from organization leadership. Conclusions Adopting sites were more likely to integrate group prenatal care when stakeholders achieved alignment across staff on organizational change goals, leadership buy-in, and committed institutional support and dedicated resources to sustain it. Trial registration The Expect With Me intervention’s design and hypotheses were preregistered: https://clinicaltrials.gov/study/NCT02169024. Date: June 19, 2014. Evaluating feedback from an implementation advisory board to assess the rollout of a postpartum patient navigation program Background Patient navigation is an individualized intervention to facilitate comprehensive care which has not yet been fully implemented in obstetric or postpartum care. Methods We aimed to develop and evaluate a mechanism to incorporate feedback regarding implementation of postpartum patient navigation for low-income birthing individuals at an urban academic medical center. This study analyzed the role of an Implementation Advisory Board (IAB) in supporting an ongoing randomized trial of postpartum navigation. Over the first 24 months of the trial, the IAB included 11 rotating obstetricians, one clinic resource coordinator, one administrative leader, two obstetric nurses, one primary care physician, one social worker, and one medical assistant. Members completed serial surveys regarding program implementation, effects on patient care, and areas for improvement. Quarterly IAB meetings offered opportunities for additional feedback. Survey responses and meeting notes were analyzed using the constant comparative method and further interpreted within the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. Results Members of the IAB returned 37 surveys and participated in five meetings over 24 months. Survey analysis revealed four themes among the inner context: reduced clinician burden, connection of care teams, communication strategies, and clinic workflow. Bridging factors included improved patient access to care, improved follow-up, and adding social context to care. Innovation factors included availability of navigators, importance of consistent communication, and adaptation over time. Meeting notes highlighted the importance of bidirectional feedback regarding implementation, and members expressed positive opinions regarding navigators’ effects on patient care, integration into clinic workflow, and responsiveness to feedback. IAB members initially suggested changes to improve implementation; later survey responses demonstrated successful program adaptations. Conclusions Members of an implementation advisory board provided key insights into the implementation of postpartum patient navigation that may be useful to promote dissemination of navigation and establish avenues for the engagement of implementing partners in other innovations. Trial registration ClinicalTrials.gov, NCT03922334. Registered April 19, 2019. The results here do not present the results of the primary trial, which is ongoing. IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation (The IMPART Study) Background In the UK, 7.6% of babies are born preterm, which the Department of Health aims to decrease to 6% by 2025. To advance this, NHS England released Saving Babies Lives Care Bundle Version 2 Element 5, recommending the Preterm Birth Pathway for women at risk of preterm birth. The success of this new pathway depends on its implementation. The IMPART (IMplementation of the Preterm Birth Surveillance PAthway: a RealisT evaluation) study aimed to research how, why, for whom, to what extent and in what contexts the prediction and prevention aspects of Preterm Birth Surveillance Pathway is implemented through a realist evaluation. Realist implementation studies are growing in popularity. Methods Initial programme theories were developed through a realist informed literature scope, interviews with developers of the NHS England guidance, and a national questionnaire of current practice. Implementation theory was utilised in developing the programme theories. Data (interviews and observations with staff and women) were undertaken in 3 case sites in England to ‘test’ the programme theories. Substantive theory was utilised during data analysis to interpret and refine the theories on how implementation could be improved. Results Three explanatory areas were developed: risk assessing and referral; the preterm birth surveillance clinic; and women centred care. Explanatory area 1 dealt with the problems in correct risk assessment and referral to a preterm clinic. Explanatory area 2 focused on how once a correct referral has been made to a preterm clinic, knowledgeable and supported clinicians can deliver a well-functioning clinic. Explanatory area 3 concentrated on how the pathway delivers appropriate care to women. Conclusions The IMPART study provides several areas where implementation could be improved. These include educating clinicians on knowledge of risk factors and the purpose of the preterm clinic, having a multidisciplinary preterm team (including a preterm midwife) with specialist preterm knowledge and skills (including transvaginal cervical scanning skills), and sites actively working with their local network. This multidisciplinary preterm team are placed to deliver continuity of care for women at high-risk of preterm birth, being attentive to their history but also ensuring they are not defined by their risk status. Trial registration ISRCTN57127874. Using an experience-based co-design approach to develop strategies for implementing an intravenous iron intervention to treat moderate and severe anemia in pregnancy in Malawi Background In low- and middle-income countries, women experiencing anemia during pregnancy are recommended to take 30 mg to 60 mg of oral iron daily throughout pregnancy. However, oral iron tablets are often poorly tolerated and slow in correcting anemia, resulting in low adherence, prolonged anemia, and increased risk of adverse maternal and fetal outcomes. An alternative to oral iron is intravenous (IV) iron, commonly used in high-income countries to restore the body’s iron stores rapidly. A randomized controlled trial was conducted to investigate the effectiveness and safety of IV iron compared to standard-of-care oral iron supplementation for pregnant women with moderate and severe anemia in the third trimester in Malawi (REVAMP-TT). Using an experience-based co-design approach, our study aimed to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi, and develop mitigating strategies for the successful implementation of REVAMP-TT. Methodology The co-design process involved two phases: i) We conducted an information-gathering exercise to identify barriers and facilitators to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi. We interviewed key informants (n = 53) including the policymakers, government partners, healthcare managers, and healthcare providers. We also gathered previous research findings from a formative qualitative study on the perceptions and experiences of IV iron treatment for pregnant women experiencing anemia in Malawi (n = 29). ii) We conducted two co-design workshops with end-users (n = 20) and healthcare providers (n = 20) to confirm and identify the key barriers and facilitators and developed mitigating strategies to inform the successful implementation of the REVAMP-TT trial. We mapped the emerging barriers to the Consolidated Framework for Implementation Research 2.0 (CFIR 2.0) and matched the mitigating strategies to the corresponding Expert Recommendations for Implementing Change (ERIC) compilation. Results The following were identified as key barriers to IV iron use to treat anemia in pregnancy in the primary healthcare system of Malawi: the cost of IV iron, the lack of available resources and knowledge, local attitudes including myths and misconceptions about IV iron and keeping pregnancy a secret, local conditions, the lack of political will and buy-in from high-level leaders, the lack of capability of healthcare providers to deliver IV iron, and the lack of male involvement to support pregnant women's access to antenatal care. The proposed strategies to mitigate the barriers for the successful implementation of the REVAMP TT trial included providing financial strategy, developing stakeholder relationships, training and educating stakeholders, supporting clinicians, and engaging end-users. Conclusion The use of the experience-based co-design approach in our study provided a valuable method to expose the potential barriers and facilitators to IV iron use and develop mitigating strategies to successfully implement the REVAMP-TT trial. Engaging both the key informants and end users promoted ownership and consensus among stakeholders and ensured a collaborative environment for sharing deeply rooted real-world experiences and insights. Not only do these findings address the needs of this study, but they also, lay a groundwork for the possible integration of IV iron into routine care in Malawi and provide knowledge for policymakers to make informed decisions on the management of anemia in the primary healthcare systems of Malawi.

Perinatal mental health disorders are prevalent in Ecuador and Peru. Despite national health policies supporting maternal mental health care, service provision remains fragmented, relying on a mix of public, private, and nongovernmental actors. This study examined professional interest holders’ perceptions of barriers to perinatal mental health care and the solutions they propose. We employed a mixed-methods approach. First, a systematic review of publicly available data was conducted to identify organizations engaged in maternal and mental health care in Ecuador and Peru. Following this, in-depth, semistructured interviews were conducted with 17 key informants representing research institutions, nongovernmental organizations (NGOs), government agencies, and private sector entities. Thematic analysis was applied to identify structural barriers, institutional challenges, and proposed solutions. Findings revealed multilevel barriers to perinatal mental health care, including stigma, financial constraints, limited provider training, fragmented health services, and bureaucratic inefficiencies. Community-based interventions, task-shifting strategies, and increased public education were identified as effective approaches to addressing these challenges. Participants also emphasized the need for intersectoral collaboration, increased governmental investment, and policy reforms to strengthen maternal mental health services. Efforts to improve perinatal mental health care in Ecuador and Peru require a combination of culturally sensitive, community-driven interventions, as well as sustainable government investment and commitment.

Perinatal mental health disorders are prevalent in Ecuador and Peru. Despite national health policies supporting maternal mental health care, service provision remains fragmented, relying on a mix of public, private, and nongovernmental actors. This study examined professional interest holders’ perceptions of barriers to perinatal mental health care and the solutions they propose. We employed a mixed-methods approach. First, a systematic review of publicly available data was conducted to identify organizations engaged in maternal and mental health care in Ecuador and Peru. Following this, in-depth, semistructured interviews were conducted with 17 key informants representing research institutions, nongovernmental organizations (NGOs), government agencies, and private sector entities. Thematic analysis was applied to identify structural barriers, institutional challenges, and proposed solutions. Findings revealed multilevel barriers to perinatal mental health care, including stigma, financial constraints, limited provider training, fragmented health services, and bureaucratic inefficiencies. Community-based interventions, task-shifting strategies, and increased public education were identified as effective approaches to addressing these challenges. Participants also emphasized the need for intersectoral collaboration, increased governmental investment, and policy reforms to strengthen maternal mental health services. Efforts to improve perinatal mental health care in Ecuador and Peru require a combination of culturally sensitive, community-driven interventions, as well as sustainable government investment and commitment.

Perinatal mental health disorders are prevalent in Ecuador and Peru. Despite national health policies supporting maternal mental health care, service provision remains fragmented, relying on a mix of public, private, and nongovernmental actors. This study examined professional interest holders’ perceptions of barriers to perinatal mental health care and the solutions they propose. We employed a mixed-methods approach. First, a systematic review of publicly available data was conducted to identify organizations engaged in maternal and mental health care in Ecuador and Peru. Following this, in-depth, semistructured interviews were conducted with 17 key informants representing research institutions, nongovernmental organizations (NGOs), government agencies, and private sector entities. Thematic analysis was applied to identify structural barriers, institutional challenges, and proposed solutions. Findings revealed multilevel barriers to perinatal mental health care, including stigma, financial constraints, limited provider training, fragmented health services, and bureaucratic inefficiencies. Community-based interventions, task-shifting strategies, and increased public education were identified as effective approaches to addressing these challenges. Participants also emphasized the need for intersectoral collaboration, increased governmental investment, and policy reforms to strengthen maternal mental health services. Efforts to improve perinatal mental health care in Ecuador and Peru require a combination of culturally sensitive, community-driven interventions, as well as sustainable government investment and commitment.

Health services provisions are crucial aspects of everyone's well-being especially pregnant women who are most often, denied access to maternal health care provisions. Previous studies on maternal health care focused mainly on economic factors as the main reason for poor utilization of maternal health care provisions without looking at the availability of maternal health care facilities particularly in rural communities. This study therefore, examined the utilization of maternal health care provisions in Orumba North Local Government Area, in Anambra State Nigeria. Structural functionalism theory provided the framework. Survey design was employed. Simple random sampling technique was used to come up with an all-female sample of 384 respondents. A structured questionnaire was used to collect demographic and the utilization of modern maternal health care provisions data. Data generated from the field are analysed through the use of descriptive statistics. Findings reveal that respondents utilize modern maternal health care facilities in the area very often (82%), however the services rendered in the modern maternal health care were not satisfactory to respondents (84%. There is respondents' unwillingness to utilize modern maternal health care provisions (88%) and an above average respondents' willingness to patronize Traditional Birth Attendants (TBAs) more than the modern maternal health care facilities (52%). This study therefore, recommends equipping modern health care facilities with both human and material resources to enhance their performance. Also, periodic training of TBAs is recommended to enable them render good and hygienic services that will reduce maternal mortality rate among pregnant women.

This commentary explores maternal and child health (MCH) care within the context of the Seventh-day Adventist (SDA) faith, where health is viewed as a spiritual obligation. Rooted in the Adventist “health message,” maternal care emphasizes holistic wellness, preventive practices, and spiritual resilience. Faith-informed behaviors—such as vegetarianism, rest through Sabbath observance, and abstinence from harmful substances—contribute to favorable pregnancy outcomes and mental well-being. Adventist communities and institutions, like Loma Linda University Medical Center, integrate modern medical care with faith-based values, offering services such as nutritional counseling, childbirth education, and spiritual support. Emotional stability is further strengthened through prayer, church rituals, and pastoral care. While tensions may arise between religious beliefs and some public health interventions, Adventist models generally align with global health goals through their emphasis on prevention, community care, and whole-person healing. This perspective underscores the potential of faith-based frameworks to complement scientific approaches in maternal and child health care.

BackgroundEnsuring equitable access to maternal health care including antenatal, delivery, postnatal services and fertility control methods, is one of the most critical challenges for public health sector. There are significant disparities in maternal health care indicators across many geographical locations, maternal, economic, socio-demographic factors in many countries in sub-Sahara Africa. In this study, we comparatively explored the utilization level of maternal health care, and examined disparities in the determinants of major maternal health outcomes.MethodsThis paper used data from two rounds of Benin Demographic and Health Survey (BDHS) to examine the utilization and disparities in factors of maternal health care indicators using logistic regression models. Participants were 17,794 and 16,599 women aged between15–49 years in 2006 and 2012 respectively. Women’s characteristics were reported in percentage, mean and standard deviation.ResultsMean (±SD) age of the participants was 29.0 (±9.0) in both surveys. The percentage of at least 4 ANC visits was approximately 61% without any change between the two rounds of surveys, facility based delivery was 93.5% in 2012, with 4.9% increase from 2006; postnatal care was currently 18.4% and contraceptive use was estimated below one-fifth. The results of multivariable logistic regression models showed disparities in maternal health care service utilization, including antenatal care, facility-based delivery, postnatal care and contraceptive use across selected maternal factors. The current BHDS showed age, region, religion were significantly associated with maternal health care services. Educated women, those from households of high wealth index and women currently working were more likely to utilize maternal health care services, compared to women with no formal education, from poorest households or not currently employed. Women who watch television (TV) were 1.31 (OR = 1.31; 95% CI = 1.13–1.52), 1.69 (OR = 1.69; 95% CI = 1.20–2.37) and 1.38 (OR = 1.38; 95% CI = 1.16–1.65) times as likely to utilize maternal health care services after adjusting for other covariates.ConclusionThe findings would guide stakeholders to address inequalities in maternal health care services. More so, health care programmes and policies should be strengthened to enhance accessibility as well as improve the utilization of maternal care services, especially for the disadvantaged, uneducated and those who live in hard-to-reach rural areas in Benin. The Benin government needs to create strategies that cover both the supply and demand side factors at attain the universal health coverage.

BackgroundHealth care workers in Kenya have launched major strikes in the public health sector in the past decade but the impact of strikes on health systems is under-explored. We conducted a qualitative study to investigate maternal and child health care and services during nationwide strikes by health care workers in 2017 from the perspective of pregnant women, community health volunteers (CHVs), and health facility managers.MethodsWe conducted in-depth interviews and focus group discussions (FGDs) with three populations: women who were pregnant in 2017, CHVs, and health facility managers. Women who were pregnant in 2017 were part of a previous study. All participants were recruited using convenience sampling from a single County in western Kenya. Interviews and FGDs were conducted in English or Kiswahili using semi-structured guides that probed women’s pregnancy experiences and maternal and child health services in 2017. Interviews and FGDs were audio-recorded, translated, and transcribed. Content analysis followed a thematic framework approach using deductive and inductive approaches.ResultsForty-three women and 22 CHVs participated in 4 FGDs and 3 FGDs, respectively, and 8 health facility managers participated in interviews. CHVs and health facility managers were majority female (80%). Participants reported that strikes by health care workers significantly impacted the availability and quality of maternal and child health services in 2017 and had indirect economic effects due to households paying for services in the private sector. Participants felt it was the poor, particularly poor women, who were most affected since they were more likely to rely on public services, while CHVs highlighted their own poor working conditions in response to strikes by physicians and nurses. Strikes strained relationships and trust between communities and the health system that were identified as essential to maternal and child health care.ConclusionWe found that the impacts of strikes by health care workers in 2017 extended beyond negative health and economic effects and exacerbated fundamental inequities in the health system. While this study was conducted in one County, our findings suggest several potential avenues for strengthening maternal and child health care in Kenya that were highlighted by nationwide strikes in 2017.