Category: MIL-OSI

Source: The Conversation – Africa – By Mario Schmidt, Associate Researcher, Max Planck Institute for Social Anthropology

Within sight of Kenya’s main international airport in Nairobi’s east, Pipeline residential estate stands out like a sore thumb. Composed almost entirely of tightly packed high-rise tenement flats, the estate has been described by the media as an urban planning nightmare. They point to its garbage problem, its waterlogged and frequently impassable streets, and the effect of dense living conditions on children’s health.

Pipeline’s transformation started roughly two decades ago. High-rise apartment blocks were a response to demand for low-cost rental housing in the rapidly urbanising capital. Individual private developers gradually converted the area, roughly 2km², into a dense, high-rise residential district. On average each block of flats hosts 200 or 300 tenants.

Pipeline is an example of how private sector developers can contribute to solving Nairobi’s housing crisis. But it’s also an example of how unregulated and poorly planned housing construction can have a negative impact on the social, economic and psychological well-being of households.

Pipeline is not the only tenement district in Nairobi. But it is one of the densest neighbourhoods in the city of over 4 million. The quality of buildings varies, but there are similarities:

• rental flats mainly comprise single rooms with shared ablutions

• unit design gives little attention to lighting, air circulation, or open space

• tenants are forced into unfavourable rental relationships, where delays or default in payments can lead to water or electricity cuts.

The flats in Pipeline are almost exclusively inhabited by rural-urban migrants. They are attracted here by cheap accommodation and the promise of modernity. The flats have running water, tiled floors, individual electric meters and formal rental agreements.

We are researchers who study urban development, urban migration, and urban communities. Our fieldwork research sought to understand how the physical and social spaces created in neighbourhoods like Pipeline shape the experience of stress and pressure among men and women. We also looked at the strategies they apply to cope or reduce social, economic and romantic pressure.

Pipeline is a marked improvement from the options provided in Nairobi’s traditional informal settlements. Still, most basic services in the area are intermittent, or privatised. This is because the unplanned densification has outpaced the capacity of public infrastructure and services. This forces residents to pay for education, health, water, recreation and other services.

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Many of these tenants are unemployed, or employed in low-wage industrial work, precarious gig work, or domestic work.

We found that men and women experience and try to cope with stress in diverse ways. Both men and women located the cause of their distress within their marital home. But the meanings and reactions to that stress diverged sharply in the migrant household.

We found that migrant men tend to experience stress in the form of pressure and migrant women in the form of tiredness.

Previous evidence points to the different ways in which stress is experienced based on biological differences between men and women. However, we propose that the tight coupling between men and pressure and between women and tiredness is the result of the expectation that men will be breadwinners. This drives men towards action and prevents women from expressing a will towards action.

Fieldwork and findings

We discovered our shared interest in studying Nairobi’s high-rise estates during a workshop on urban Nairobi.

Mario had carried out longitudinal ethnographic work with rural–urban migrants in Pipeline. His two-year-long fieldwork mostly took place in near-exclusively male spaces, such as gyms, barber shops and bars. Roughly 50 in-depth qualitative interviews revealed how men navigated urban lives that were increasingly defined by stress, pressure and exhaustion.

Miriam’s research focused on how Nairobi’s privately developed low-cost tenement precincts created environments of everyday urban dysfunction.

After the first meeting, we concluded that it would be beneficial to get a deeper understanding of women’s experiences of stress. This would help us to understand men’s and women’s experiences of stress and pressure. It would also enable us to compare how these different groups managed and coped with stress.

We designed a semi-structured questionnaire and conducted interviews with a dozen female residents. The interviewees spanned single and married women, members of a financial self-help group (chama), female neighbours who usually spent time together on balconies, a sex worker, and an entrepreneur who owned a hair salon.

Comparing the two sets of interviews provides ethnographic support for our hypothesis, which is that men and women tend to experience different types of stress: masculine “pressure” and feminine “tiredness”.

Masculine pressure is defined as an experience that provokes action. The pressure is intrinsically attached to the cause of stress and driven by the hope that overcoming it will promise social validation linked to the male provider model.

The male interviewees tended to engage in outward-oriented strategies to overcome this pressure. These include social drinking, extramarital affairs, or violent reaffirmations of gender identity. In this way, the form and design of Pipeline offered plentiful avenues for commercialised, stress-reducing activities.

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In contrast, feminine tiredness emerged as an experience that inhibited action. Female respondents were constrained from aggressive responses, lest they risk being branded immoral or losing vital male financial support.

Married women, or single parents, found themselves largely confined to the small apartments. Their inward-oriented coping strategies were sometimes identified as “doing nothing” or watching TV, or performing household tasks. This passive endurance of stress was also seen as a means to “persevere” (Kiswahili: kuvumulia). In some cases, women used intermediate semi-private spaces, such as balconies, chamas or church, to connect with neighbours.

Taken together, these responses and expectations structure the modes by which male and female migrants react to or attempt to mitigate or relieve stress. This stress is not only caused by poverty but by expectations of middle-class success, ideals of romantic family life and economic progression.

Conclusions

As yet, there are no policies or programmes that seek to reverse the complex challenges created through neighbourhoods like Pipeline. Kenya’s national affordable housing programme is focused on home-ownership solutions. However, with over 90% of the city’s population renting their dwellings, and 87% renting from private individuals, Nairobi needs a better solution for rental housing.

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This could be through redevelopment and area-based upgrading, expansion of basic social and community services, incentives for private developers to incrementally upgrade their housing stock, rental and tenant protection legislation, and support for sustainable, communal, and cooperative housing alternatives spearheaded by citizens themselves.

Mario Schmidt received funding from the German Research Foundation and the Max Planck Institute for Social Anthropology. He currently works for Busara, Nairobi (Kenya).

Miriam Maina undertook this research as part of her Postdoctoral research work at the African Cities Research Consortium (ACRC) in the University of Manchester. The ACRC is a a six-year investment by FCDO to fund new, operationally-relevant research to address intractable development challenges in African cities.

– ref. High-rise living in Nairobi’s Pipeline estate is stressful – how men and women cope – https://theconversation.com/high-rise-living-in-nairobis-pipeline-estate-is-stressful-how-men-and-women-cope-265499

Source: The Conversation – Africa (2) – By Mary Kinney, Senior Lecturer with the Global Surgery Division, University of Cape Town

Nearly one million babies are stillborn in Africa every year. Behind every stillbirth is a mother, a family and a story left untold. Most of these are preventable, many unrecorded, and too often invisible. Each number hides a moment of heartbreak, and every uncounted loss represents a missed opportunity to learn and to act.

As a public health researcher specialising in maternal and newborn health, I have spent the past two decades working on strengthening health systems and quality of care across Africa. My research has focused on understanding how health systems can prevent stillbirths and provide respectful, people-centred care for women and newborns. Most recently, I was part of the team that led a new report called Improving Stillbirth Data Recording, Collection and Reporting in Africa. It is the first continent-wide assessment of how African countries record and use stillbirth data.

The study, conducted jointly by the Africa Centres for Disease Control and Prevention, the University of Cape Town, the London School of Hygiene & Tropical Medicine and the United Nations Children’s Fund, surveyed all 55 African Union member states between 2022 and 2024, with 33 countries responding.

The burden of stillbirths in Africa is staggering. Africa accounts for half of all stillbirths globally, with nearly eight times higher rates than in Europe. Even stillbirths that happen in health facilities may never make it into official statistics despite every maternity registry documenting this birth outcome.

Part of the challenge is that there are multiple data systems for capturing births and deaths, including stillbirths, like routine health information systems, civil registration and other surveillance systems. But these systems often don’t speak to each other either within countries or between countries. This data gap hides both the true burden and the preventable causes.

Despite advances in several countries to prevent stillbirths, large gaps remain, especially on data systems. Only a handful of African countries routinely report stillbirth data to the UN, and many rely on outdated or incomplete records. Without reliable, comparable data, countries cannot fully understand where and why stillbirths occur or which interventions save lives.

Strengthening stillbirth data is not just about numbers; it is about visibility, accountability and change. When countries count every stillbirth and use the data for health system improvement, they can strengthen care at birth for mothers and newborns and give every child a fair start in life.

Findings

The report was based on a regional survey of ministries of health. This was followed by document reviews and expert consultations to assess national systems, policies and practices for stillbirth reporting and review.

The report reveals that 60% of African countries have national and sub-national committees responsible for collecting and using stillbirth data, which produce national reports to respective health ministries. But data use remains limited. Capacity gaps, fragmented systems and insufficient funding prevents many countries from translating information into action.

To guide investment and accountability, the report categorises countries into three readiness levels:

1. Mature systems needing strengthening, such as Kenya, Rwanda and Uganda. These countries have consistent data flows but need more analysis and use.

2. Partial systems requiring support, where reporting mechanisms exist but are not systematically implemented, like Ghana, Malawi and Tanzania.

3. Foundational systems still being built, including fragile or conflict-affected countries like South Sudan and Somalia. Here, policies and structures for data collection and use remain absent.

The findings show both progress and persistent gaps. Two-thirds of African countries now include stillbirths in their national health strategies, and more than half have set reduction targets. Nearly all countries report that they routinely record stillbirths through their health sectors using standard forms and definitions, yet these definitions vary widely. Most systems depend on data reported from health facilities. But the lack of integration between health, civil registration and other data systems means that countless losses never enter national statistics.

For example, if a woman delivers at home alone in Mozambique and the baby is stillborn, the loss is only known to the family and community. Without a facility register entry or civil registration notification, the death never reaches district or national statistics. Even when a stillbirth occurs in a health centre, the health worker may log it in a facility register but not report it to the civil registration system. This means the loss of the baby remains invisible in official data.

What this means

Stillbirths are a sensitive measure of how health systems are performing. They reflect whether women can access timely, quality care during pregnancy and at birth. But unlike maternal deaths, which are often a benchmark for health system strength, stillbirths remain largely absent from accountability frameworks.

Their causes, like untreated infections, complications during labour, or delays in accessing emergency caesarean sections, are often preventable. The same interventions that prevent a stillbirth also reduce maternal deaths. These improve newborn survival, and lay the foundation for better health and development outcomes in early childhood.

Accurate data on stillbirths can guide clinical care and direct scarce resources to where they are needed most. When data systems are strong, leaders can identify where and why stillbirths occur, track progress and make informed decisions to prevent future tragedies.

The analysis also highlights promising signs of momentum. Over two-thirds of countries now reference stillbirths in national health plans, an important marker of growing political attention. Several countries are moving from isolated data collection to more coordinated, system-wide approaches. This progress shows that change is possible when stillbirths are integrated into national health information systems and supported by investment in workforce capacity, supervision and data quality.

What’s needed

Africa has the knowledge, evidence and experience to make change happen.

The report calls for harmonised definitions, national targets and stronger connections and data use between the different data sources within and across African countries. Above all, it calls for collective leadership and investment to turn information into impact, so that every stillbirth is counted, every death review leads to learning and no parent grieves alone.

The author acknowledges and appreciates the partners involved in developing the report and the support from the Global Surgery Division at UCT.

Mary Kinney and the team at UCT receive funding from UNICEF, Laerdal Foundation, and the South African Medical Research Council.

– ref. Africa’s hidden stillbirth crisis: new report exposes major policy and data gaps – https://theconversation.com/africas-hidden-stillbirth-crisis-new-report-exposes-major-policy-and-data-gaps-268901