"There is a light that our wives had not seen before": community perspectives on a gender-responsive maternal health intervention in Western Kenya.

backgroundThe Chamas for Change (Chamas) program is an innovative three-year community-based gender-responsive intervention in Western Kenya. During this period, the program provides peer support, microfinance initiatives, and health education to pregnant women. A randomized control trial demonstrated significant improvements in maternal and child health outcomes for program participants. This qualitative study explored community perceptions of the program.

methodsWe 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

resultsPre-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 financial 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 microfinance component created participation barriers for the poorest women.

conclusionThe Chamas program's integrated approach was viewed favorably across SEM levels showing benefits for individuals and communities. Results show benefits for individuals and communities. Multiple participant perspectives provided comprehensive understanding of the program's effect. Future research should examine modified microfinance models to enhance accessibility for the poorest women and explore program application in similar settings.