As coined by Kimberlé Crenshaw, intersectionality exposes systemic inequalities and oppression that marginalized people experience (12). It gives a critical analysis of how different social identities are intertwined, breeding both privilege (access to resources) and oppression (limited access to resources). When we relate this to our analysis, we can recognize that healthcare disadvantages in these communities come from a multiplicity of factors - gender, socioeconomic status, geographic location - all of which compound each other.  

This theory has been supported in communities across the world, and Rural West Kenya is no exception. In 2011, a conference on maternal health in Kenya took place in Nairobi, organized by the Woodrow Wilson Center as a part of their Global Health Initiative. Among the panelists was Laurence Imamari, director of the Population Studies Research Institute, who spoke about maternal health in rural Kenya. She explains, “Maternal mortality in rural Kenya is still very high…Rural women in Kenya need to have increased access to maternal health services” (13). Citing a 2010 study from the Woodrow Wilson Center, she cites transportation as a key barrier, also including a need for family planning (only 35-40% of married Kenyan women use family planning, and the number may be even higher in rural areas) and lack of skilled birth attendants (14). 

The Landscape of Global Health Inequity, a book released in 2024,  uses rural Kenya as an example to detail the intricacies of healthcare delivery. Their findings match the trends seen above: 77% of rural women (compared to 97% of urban women) deliver in health facilities, 19.5% of rural women have health insurance (compared to 38.9% of urban women) urban women have access to more reliable and affordable transport, corruption significantly increases the cost of rural healthcare facilities (15). However, a large portion of their analysis particularly focuses on sociocultural factors (cultural practices and beliefs, social expectations, social responsibilities) that hinder women’s healthcare in these rural areas. While commenting on foreign cultural factors is a dangerous game (ripe for ethnocentrism that plagues health-focused sociology), the authors urge solutions to navigate around these cultural systems, instead of dismantling them. What we learn from this book is the inefficacy of the “one-size-fits-all” healthcare system in Kenya. 

During our visit to the rural villages of Funyula constituency, it was notable that most young girls are pushed to early marriages because of poverty. On the other hand, young and unmarried mothers talked about being socially stigmatized and mistreated by society generally and healthcare facilities/institutions specifically.  Most of them also complained about having limited autonomy over the decision to seek health care services, or even the finances to do so. Further, a good number of the women we engaged with experienced high levels of poverty and experience food insecurity. 

Our team encountered one such woman from Namasumbi village during one of the village gatherings. She narrated to us how she had left her 15-year-old son in the house after being hit by a motorcycle and she didn’t have the finances for either transport or treatment. She had resorted to traditional medication, but the situation was getting worse. 

Another woman recounted when she had lost her daughter during birth. She barely had money to take her to the morgue and had to improvise a way to preserve her daughter’s body. She opted for the traditional method; one puts sand on the floor with banana wigs and places the body there. Unfortunately, such heart-breaking stories weren’t rare. 

Lack of finances was by and large the biggest challenge this community faces. Poor infrastructure (especially poor roads and healthcare facilities) worsens this reality. Most of the facilities are also located far away from most of the marginalized population. The ones that are near, thus, serve a huge number of people and become overstretched, barely equipped to handle the influx. While our team was on the ground, most facilities were closed due to the doctor's countrywide strike that had paralyzed service delivery.  The strike had been ongoing for more than a month, and one can only imagine the impact. We also noted a specific lack of medical/healthcare literacy - many girls had difficulty demonstrating how to wear a pad. 

Gender was a significant factor that contributed to health inequity in Kenya. Most women we met with reported being mistreated in the hospitals depending on the kind of disease or attention they needed (e.g., many who were diagnosed with HIV/AIDs were always associated with immorality).  We also noted a gender-biased curriculum on matters of access to maternity services and a lack of emphasis on menstrual health.