Introduction

When Josephine Majani arrived at Bungoma County Hospital, all she expected was the safe delivery of her baby.  

But despite a new national policy entitling her to free maternity care, that was not what she got. First, hospital staff forced Josephine to pay for the medicine she needed to induce labor. Then she was left to deliver on her own. 

Nobody checked on her. When she walked to the delivery room for help, staff chased her out. Trying to return unaided to the labor room, she collapsed and gave birth on the concrete floor. As she lay fading in and out of consciousness, nurses repeatedly slapped and verbally abused her for having dirtied the floor. She was forced to clean up her own placenta as punishment.  

“The whole world saw me like that,” says Josephine. “Hopeless, with no one to help me.”  

What happened to her that day in 2013 would—eleven years later—result in a legal victory affirming the right of all Kenyans to quality maternal care. But there was a long fight ahead.

Hard-earned win

Hard-earned win

Josephine’s story is just one example of an all-too-common occurrence. Neglect, physical abuse, and other forms of mistreatment remain pervasive in maternity care, both in Kenya and across the globe. When Josephine spoke out, it was not just for herself but also for the many other pregnant people who had experienced similar violence—and those who would otherwise continue to.  

In 2014, The Center for Reproductive Rights filed a case on Josephine’s behalf, arguing that Josephine’s constitutional and human rights had been violated. It asked the court to affirm the rights of all pregnant Kenyans and hold the government accountable for violations of those rights.  

“[The Center] showed up for me when I had no one else to turn to and gave me the legal support I couldn’t afford on my own,” says Josephine. “Just knowing I wasn’t alone made a huge difference.” 

In 2018, the Kenyan High Court ruled in favor of Josephine. It found that the hospital had violated her human rights to dignity and freedom from cruelty, as well as her—and all Kenyans’–constitutional right to quality maternal health care. And it emphasized the need to improve policies so that all Kenyans could enjoy that right. Josephine was awarded damages for the suffering she had endured.  

But the Bungoma County Government appealed the decision. Despite video and eyewitness accounts of Josephine’s abusive treatment, the County argued that there was no evidence her rights had been violated. They asked the Court to take away the money Josephine had been awarded. For Josephine, the appeal reopened the painful chapter that the first ruling had seemed to close.  

It was another six years before the second decision came. In it, the Court of Appeal dismissed Bungoma County’s argument and affirmed the 2018 decision. It underscored the obligation of health services to respect Kenyans’ sexual and reproductive rights, and the importance of holding them accountable for violations.  

“When we won the case, I felt a mix of relief, joy, and peace,” says Josephine. “It was like a huge weight had been lifted off my shoulders. After everything I had been through, finally hearing that we got a favorable ruling felt like being heard and validated. I also felt very  proud, not just for myself, but for every woman who’s gone through something similar.”

Speaking up

Speaking up

“Being part of these cases has changed my life in so many ways. It opened my eyes to how powerful it is to speak up, even when it’s scary,” says Josephine. “I used to feel alone in what I went through, but now I know my story can help others. I want to be part of making sure no one else has to go through what I did.” 

There’s still work to be done. Even though quality maternal care is now guaranteed by law, its actual implementation is another matter. Too often, people don’t know their rights well enough to know when they’ve been violated. And while hospitals are required to inform them, they often fail to do so.  

Josephine plans to continue the fight—and hopes others will too. “Stay patient and keep pushing,” advises Josephine, “even when things get tough. Find like-minded people and groups who also support you—having a solid team makes a huge difference. Also, always remember why you started. Your passion and personal story are powerful tools, so use them to keep going and inspire others along the way.”