REARCH _WOMEN AND MENTAL HEALTH in NRB 1998_ 2014

Women and Mental Health in Nairobi, Kenya. A Situation Analysis. Shibero Akatsa 1997 - 1998
WOMEN AND MENTAL HEALTH
IN NAIROBI, KENYA
A Situation Analysis: July 1997. Reviewed 2014.
Researched and Compiled by
Shibero Akatsa

Copyright by S. A. Darby 1998.
All rights reserved
The right of S A. Darby to be identified as the author of this work has been asserted by
S.A.Darby, in accordance with the Copyright, Designs and Patents Act, 1988.
Publisher prefix 0 9535071
ISBN 0 953507106
First published in 1998 by:
REFLECTIONS
2 Streather Road. Four Oaks
Sutton Coldfleld. Birmingham,
West Midlands B75 6RD
Tel/Fax: 0121 308 0988
E-mail: s.aka.-darby@pop3.poptel.org.uk

TABLE OF CONTENTS
TITLE PAGE NOS.
CONTENTS i - ii
INTRODUCTION iii
PREFACE iv
ACKNOWLEDGEMENTS v
1. EXECUTIVE SUMMARY 8-9
2. OBJECTIVE OK STUDY 10
Problem identification 10
Long term aims of study 10
3. METHODOLOGY 11-14
Methods and justification 11
Study sites 1I
Profile of sample group 12
Local participation 12
4. DATA COLLECTION 13
Briefing and training 13
Protesting of study tools 13
Data collection process 13
Data analysis 13
Social/political environment 14
5. NAIROBI, KENYA WIDER CONTEXT 15-18
Kenya 15
Nairobi 18
6. FINDINGS 19-31
Literature search 21
Qualitative and quantitative analysis 2I
Profile of participants 21
Sample group analysis 22
Mental health diagnosis 23
Service providers feedback 24
Health professionals on mental health 24
Local non government organisations service providers 25
Qualitative/quantitative study feedback 25
Focus groups feedback 27
7. CONCLUSION 32
Summary 32
8. RECOMMENDATIONS
Development consultants 34
Proposed project 34
9. BIBLIOGRAPHY 36
10. APPENDICES 38
Justification and purpose of situation analysis
In d ivid u al interviews sample questions
Sample questionnaire
Focus group themes
ALMA ATA: Primary health concepts and challenges
M in is t r y of Health : Kenya's health policy

INTRODUCTION
Various research studies on mental health in developing countries, reflect major short comings that limit the
development of effective and appropriate mental health interventions
Apart from being highly academic, these studies focus on curing the numbers of visible sufferers through the
understanding that the origins of their illness is due to the sufferers inability to readjust to the norms of
society, often turning to personality traits and biological factors Alternatively there are those studies that argue
that the individual 's mental welfare is dependant on social group influences and their environment Both
schools of thought fail to recognise the need to identify high risk groups and prevent mental health illness
before attempting to cure it when it has become irreversible
The biggest shortcoming however, are the eurocentric models and theories used to test ' western developed '
hypotheses, m environments where traditions and cultures greatly affect the behaviour and attitudes of
communities This ignores and undermines the power of indigenous cultures and those traditions that govern and
dictate individual and community behaviour. These are major clues in understanding individual and
community responses, which affect individual mental welfare.
Study Objectives
The overall objective of the study is to explore the factors leading to the high rates of mental health disorders in
women in Nairobi, with the aim of developing appropriate and effective mental health interventions for women
and the community at large. The study and need for action has been initiated by numerous women living and
working in Nairobi, and after further reading on past research in this area of women, urbanisation and mental
health
This study Women and Menial Health in Nairobi Kenya, aims to address the shortcomings of studies done on
mental welfare in developing countries. It focuses on tackling a major stress to communities i.e. urbanisation.
Because of the existing vulnerabilities and pressures women face as a group, they are the focus of the study.
To obtain the required information, a practical, cross cultural and social model, sets out to examine the cultural
and social context that women exist in, within Nairobi Women at all levels are involved in discussions that are
relevant to their everyday lives, this is with the aim of giving the study in-depth understanding of the shared
cultural meanings, behaviour and experiences shared by women and other sections of the community
Tins process also helps the study identify those groups at risk and those already suffering from mental health
disorders on the streets and in communities.
Tins study then links individuals suffering from mental health disorders and those at risk, back into the
community (through understanding how the communities work), making it possible to draw on community
action, in developing appropriate, effective and acceptable interventions that can be acted upon by individuals
and the community.

Shibero Akatsa-Darby
Born in 1960 in Kakamega Western Kenya, Shibero is one of seven siblings, Shibero's parents migrated from
Kakamega to live in Nairobi city in the early sixties It was in Nairobi that Shibero had her primary and high
school education After high school., Shibero went to the USA for further studies where she graduated with a
BSc in media production and speech communication
On her return to Kenya, Shibero was employed as a human resources and management consultant by an
international audit and management consultancy, where she worked for three years. Here she was single, with a
well paid job, a car and her own flat. Little did she know that this was only the beginning of her troubled life in
Nairobi as a single working woman. She found herself faced with a cross section of stresses and challenges. She
begun to suffer from migraines. She became extremely unhappy in Nairobi.
Shibero now realises that she was one of many women in Nairobi, who had been suffering from mental health
disorders. She considers herself fortunate. Other female friends had not survived. A close high school friend had
committed suicide, two other high school colleagues had suffered from mental breakdowns without recovering,
two of her female cousins had also had breakdowns, with one of them irreversible since 1994, her eldest sister
too, has had two strokes leaving her totally incapacitated She had been diagnosed as being clinically depressed.
All these women once lived and worked in Nairobi, and had been resourceful and productive members of the
community.
Shibero's way of coping with her mental state whilst in Nairobi, was to resign from her job, sell her car and
move to the UK, where she hoped for better opportunities professionally and in search for peace of mind
It was in the UK, that Shibero found help for her mental welfare. She has since done post graduate studies and
qualified as a psychotherapist; a relationship therapist, a drugs and alcohol abuse counsellor/educationist, and a
personal development trainer. Since 1993 Shibero has been practising in the UK, as a counsellor/therapist
guided by qualified supervisors, case discussion groups and running personal development workshops. Her
other work experiences in the UK include personal and life skills training and development, human resources
management, quality management, community development and international community development and
project development
She currently sits on the board of an international development organisation based in Leicester UK, and in 1995
sat on the board of an international health development sending agency, based in London She has also written
several published articles for a couple of international development organisations in London. Shibero is a
member of a women's Educational Trust based in the Midlands (Birmingham)
This study was inspired by Shibero's personal experiences and the numerous women in Nairobi who had been
affected by mental health disorders (append .32). Since the completion of the study, Shibero's sister has since
passed away.

ACKNOWLEDGEMENTS
In Nairobi, Kenya
A special thanks, to all those 170 women, who disclosed their personal stresses, in the completion of the
questionnaires and participated in the focus groups. I hope this piece of research is a tool that will enable us to
put in place interventions that will help make our lives in the Nairobi communities more manageable and less
stressful, whilst enabling us to take the opportunities presented by urbanisation.
I would also like lo thank all those men and women who got involved in any of the discussions at an informal
level, and to the following.
ABANTUL: Ms Wahu Karaa. Regional Programme Manager
Dept for International Dev: Mr. David Fish: Head of Development Division and
Ms. Jackie Munch. Health & Population Field Manager
Centre For Family Studies: Ms. Mary Mujomba. Programme Officer
and Ms Dolorita Onguru. Assistant to Director
Home Economics Association for Africa: Ms .Jean Kiviu. Secretary General
Kenya Medical Women's Ass: Mrs. Abigail Kidero and members who participated
Kenya Army Medical Centre: Professor James Ayugi;
Kwengo: Mr. Chris Ovucho. Membership Liaison Officer
Ministry of Health: Documents department. Schizophrenia Found.of Kenya-Ms Lillian Kanaiya, Karen
Syn-thesis Architects: Mr Anzaya Akalsa: Professional Touch - Mrs Mbithe Anzaya: Langata
Simba Air Cargo Ms Sophie Ambale: Research Assistants - Loreen Wanjiri, Susan Kaai. Tibag Talitwala.
Wabugha Kubo. Praxedes Ndindi. Bilha Muna.
And for all the endless support from the following in the UK, without whom the research may not have
taken place. Thank yon.
Skillshare Africa Leicester. UK: Board of Trustees.
Skillshare Africa. Leicester. UK: Dr Cliff Allum. Director
Barrow Cadbuiv Trust. Bum UK: Mr Erick Adams. Director
Women Acting In Today's Ms Joan Blancv . Director
Society (WAITS):
Development Consultants: Skillshare Africa. Valeric Griffith. Tina Garamzcgi
Dept of Urban Development Academic Collaborations
&. Policy. South Bank University. Professor Trudi Harpham
London/School For Tropical Medicine Ms Ilona Blue: Assistant Researcher
World Health Organisation Ms Grisette: Documentation Depart.

1. EXECUTIVE SUMMARY
The study Women and Mental Health in Nairobi, Kenya, was initiated by women li ving and working in
Nairobi It set out to explore the factors leading to high rates of mental health disorders of women in
urbanisation i.e. Nairobi, with the aim of developing appropriate and effective mental health interventions, for
women, families and communities
Methodology
To obtain the required information, a practical, cross cultural and social model, was developed with the aim of
examining the cultural and social context that women exist within Nairobi. Women at all levels were
involved in discussions that were relevant to their everyday lives, this we hoped would give the study in-
depth understanding of the shared cultural meanings, behaviour and experiences shared by women and other
sections of the community.
We hoped this process would also help the study identify those groups at risk and those already suffering from
mental health disorders on the streets and the communities.
The study then linked individuals suffering from mental health disorders and those at risk, back into the
community (through understanding how the communities work), making it possible to draw on community
action, in developing appropriate, effective and acceptable interventions that can be acted upon by individuals
and the community
The study methodology that was used involved four types of research activities:
A literature search involving the collection and review of information on women and mental health disorders
in urbanisation, in the form of research reports, publications, magazines and literature conducting of ‘key
informant’ interviews with various service providers of health related services, and services for women in
Nairobi in depth focus group discussion wi t h women wit hin Nairobi a questionnaire that measured mental
health disorders, developed by WHO (The SRQ-20 questionnaire) in 1988 to assess mental health status
especially for use in developing countries
The questionnaire allows a non-specialised person to identify individuals with mental health problems12.
The
main aspects of the questionnaire concern anxiety, depression and psychosomatic problems, which according to
medical and community studies, are the most frequent expressions of mental troubles. The ‘cut-off’ point for the
SRQ-20 used for differentiating probable cases from non-cases was 7/8. This was decided upon after analysing
past SRO-20 research implemented in Kenya, i.e.Kisii, Kisumu and Kenyatta National Hospital. 3
The questionnaire also included women's various stresses, support services, recommendations, and socio-
economic details
All research methods were deployed to ensure effective evaluation and assessment of women and mental
health in Nairobi
The methodological steps were:
Collating relevant data on women and mental health disorders at a global level - this was to obtain a situational
understanding of the implementation issues of the ground research.
Developing research instruments for the interviews and focus group discussions. The aim of this was to
identify critical issues which would form the basis for the unstructured discussions, and the questionnaire
Finally, the various data was processed and synthesised to write the report
The research contained both quantitative and qualitative performance indicators.
8

Preparation for the study begun in July 1996 and was supported by the following organisations in the UK:
 Skillshare Africa, an international development organisation based in Leicester. UK.
 Women Acting In Today's Society (WAITS), a West Midlands community based, women's educational
trust UK.
 Barrow Cadbury Trust, a UK based funding trust for community based projects.
 Two research academic collaborators from South Bank University in the School of Tropical Medicine.
London. UK.
Field work in Nairobi was scheduled started in July 1997, over a period of 14 working days.
Main Findings
Women face a host of socio-cultural and socio-economic problems, highlighting the subordinate and extremely
vulnerable position they have in society. Inequities lead to legal, social and economic helplessness, dependency
on others, chronically low self esteem and low aspirations. This situation finds most women without sustainable
coping skills or family or community support, that if they had would make a difference in preventing or
reducing physical and mental health problems.
Within the adult population, there is a particular peak of depression in women aged 30 - 45 years. This affected
their family relationships, their ability to parent their children and function within their work place. Mental
health disorders arc also affecting girls as young as twelve years old.
Evidence within the community suggests that the public, including health professionals, arc unaware of mental
health issues, with many believing it to be an illness that is incurable and or non- preventable. This
consequently creates phobias and 'taboos', stigmatizing ill mental health, which is perpetuated from generation
to generation.
Recommendations
Based on recommendations of all those people involved in the study, and guided by World Health
Organisation's ALMA ATA Primary Health Care Concepts in a Changing World
An urban focused project, managed by women, that will work in partnerships with community based
organisations, local NGOs, local institutions, health professions and individuals, sharing resources,
information, education and life experiences
The project should aim to:
Promote the self reliance and mental well being of women, families and the urban communities, through
providing a comprehensive support service that will aim to:
 build and promote community and individual mental health support
 create and promote social awareness on mental health issues
 raise the profile, self esteem and opportunities for women, through access to information and life
 skills development
 advocate and lobby on behalf of women, on issues affecting women's mental welfare
 carry out research and development activities on women, family and mental health, with the aim of
developing appropriate services for those affected.
The proposed project should aim to be inclusive, recognising that men need to make an equal contribution to the
development of the service.
9

2. OBJECTIVE OF STUDY
The main purpose of the study was to explore factors contributing to women's mental health disorders in
Nairobi, given the fact that Nairobi city has seen rapid changes since independence.9
2.1 Problem Identification
Evidence that women arc not coping effectively is a grave concern expressed and identified by friends, relatives
and families in Nairobi affected by mental health disorders, by sufferers, health professionals, and finally by
local and international research development academics and World Health Organisation (WHO)
The above groups say that the numbers of people suffering from ill mental health is on the increase, evident in
the overcrowded mental institutions with spillage of patients onto the streets of Nairobi. The situation is now
urgent. As one woman succinctly summarises the need for action:
“Yesterday it was….x…. for all I know, kesho ni mimi (tomorrow is me), or my children. What
would 1 do, where would I go? And what would happen to my family?"
The groups expressed the need to pool resources that would help develop interventions that women, families
and communities would benefit from.
2.2 Long Term Aims of Study
To enable women in Nairobi to develop a project that will provide families and those communities affected by
or are at risk of mental health disorders to achieve the following:
Develop social support systems, interventions etc relevant to the stresses faced daily within their communities,
consequently reducing the numbers of women and families suffering from mental health disorders.
Create an understanding of mental health issues i.e. education, detection, and prevention in families and
communities, consequently creating greater and healthier knowledge and altitudes on mental health welfare.
Develop support systems/ interventions for those families/ people caring for those affected by mental health
disorders.
10

3 METHODOLOGY OF STUDY
3.1 Methods and Justification
The quantitative methods (append 14) used allowed the study to obtain a wide range of specific and factual
information from a large cross section of women in Nairobi
Structured questions in the form of a questionnaire, were designed and translated into Swahili. (National
language) The questionnaires were designed to elicit the following information from women:
socio-demographic features
mental health assessment, using *SRQ-2() questionnaire
social support networks
main life stresses
The qualitative (append 35) methods allowed for deeper understanding from women, regarding their experiences
within the context of their social world and the customs and traditions which govern their welfare. This method
also allowed for deeper understanding of the wider communities altitudes and awareness of mental health issues,
as well as understanding the health services and how they arc managing this particular aspect of health,
especially with women
Unstructured in-depth discussions were implemented through use of focus groups with women who had
completed the questionnaires (append .15). Topics for discussion were based on the following themes:
socio-cultural/ socio-economic expectations, attitudes and pressures from the wider community
main life stresses affecting women's mental health
individual and community social support systems and attitudes ill mental health women's attitudes/
feelings towards themselves and their mental welfare
One to one interviews with un/structured questions were also used with local non-government
organisations, mental health professionals, church and community representatives. (append 33).
3.2 Study Sites
The study was to be implemented within Nairobi city and its environs, mainly those areas within a fifteen mile
radius from the city centre, namely the following estates:
Nairobi West. South “C” Upper Hill, Kenyatta. Kibera, Kileleshua. Langata. Westlands,Parklands. Pangani.
Lavington. Woodley. Ngong Road. Starehe. Jogoo Road, and Buru Buru
The selected sites represented a cross section of socio-economic features
11

3.3 Profile of Sample Group
Women from the ages of 18 - 55 years, living within the described areas at the time of data collection The
rationale behind choosing this age group was that this group was identified as being high risk for mental health
disorders because they arc at the forefront of urbanisation
Women were interviewed ad-hoc within their homes or at their places of work and or on the streets of Nairobi.
3.4 Local Participation
Apart from the sample group, local non-government organizations (NGOs), lead health decision makers, health
professionals and community leaders were invited to participate in the study at random. The following finally
accepted to lie involved in the study:
Abantu For Development
Department for International Development (DFID)
Centre For Family Studies (CFAFS)
Home Economics Association For Africa
Kenya Medical Women's Association
Ministry of Health
National Council For NGOs
Oasis Counselling Centre and an Anonymous Counselling Centre
Schizophrenia Foundation of Kenya
3 Church representatives from Nairobi based
churches
A total of 18 interviews took place, all on the premises of the individual organisations.
12

4. DATA COLLECTION
Six research assistants were recruited by a qualified and experienced graduate Researcher.
4.1 Briefing and Training
Two days were allocated to briefing the research team by the lead researcher The briefing
focused on:
background of the study
understanding of the study tools
data collection procedures
personal safety and debriefing procedures
4.2 Pre-testing of Study Tools
The following were the tools that were pre-tested:
questionnaires
focus groups discussion questions
one to one interview questions
Study tools were pre-tested at random and informally within various communities, prior lo being used during
the final study. This ensured information relayed and received was clearly understood responded to accordingly.
The pre-testing also ensured that the questions being asked conveyed the same meaning to the interviewees and
interviewers.
4.3 Data Collection Process
Quantitative data, along with the allocated sites were distributed to the research assistants. The teams met every
two days to review and debrief after data collection. Any problems or issues concerning the data collection, or
personal concerns flagged up by the collection, were discussed.
Qualitative data was collected through taped interviews.
4.4 Data Analysis
All data collected was entered into the computer and analysed and interpreted by the research team, a consultant
statistician and two development consultants.
4.5 Social and Political Environment
Nairobi was in turmoil during the study. One week prior to the study, there were political riots occurring and a
number of people had been killed by the police.

The International Monetary Fund had also suspended a major loan to Kenya because of the lack of economic
reforms previously promised by the Kenyan government.
Kenya was also due to have elections before the end of the year i.e. 1997.
BACKGROUND AND WIDER CONTEXT OF NAIROBI, KENYA
5.1 Kenya
Geography
Kenya, an East African country, highlights the undergoing rapid urbanisation process. Kenya is bordered by
Ethiopia and Somalia on the north and north-east; by Sudan on the north-west and by Uganda on the west, by
Tanzania on the south and by the Indian Ocean to the cast.
Straddling the equator. Kenya enjoys a tropical climate and is famous for tourism due to its many game parks. It
is also famous for its exports of tea. coffee, flowers, pineapples and green beans, (and for its long distance
runners!).
Population31
Kenya's population increased from 5.4 million in 1948 to 15.3 million in 1979. It now has a population of 28.4
million people, all of who belong to 13 different tribes mainly Kikuyu 22%, Luhya 14%, Luo 13%, Kalenjin
12%, Kamba 11%, Gusii 6%, Tribal traditions and political loyalties arc a significant factor in people's lives.
Kenya has the fastest population growth in Africa, estimated to be at 3.8 per cent per annum, with fertility rates
estimated at 5.4 births per woman (1996). 50.4 % of the population comprises of women., 49 6% of men,
with life expectancy is at 51 years for men (1996) and 52 for women.
Net migration rate is -0.34 migrant(s)/1000 population mainly from the rural areas.
Religion 32
Christianity has expanded rapidly from about 25% to about 73% in recent years, with about 19 % traditional
religions and 6% Muslim,
Education 32
Swahili and English arc the main written and spoken languages. Out of a total population of over 15 years of
age, the literacy rates of males arc at 86.3 % and females at 70%.
Employment 32
The labor force totals 8.7m with agriculture providing employment for over 75% of the population and non-
agriculture 20%-25% in 1993, with females at 39% and males at 61%. New employees into the jobs market
number 0.4m - 0.5m per year.
The government estimates the informal productive sector i.e. jua kali: welders, metal workers, mechanics,
carpenters, and construction workers and hawking i.e. small scale businesses in perishable goods e.g. sweets,
cooked food, charcoal soft drinks etc. range from 1.47m (199.3) to 6.54m (1994 -6).
Public Health32
Hospital beds number about 40.000, there are several private hospitals, health centres and dispensaries. There
was one doctor per 7.410 inhabitants in 1993. Child malnutrition was estimated to be 22% in the period 1985-
93.

Malaria is the main endemic health problem and totals more than 25% of all reported illnesses countrywide. In
terms of mortality, malaria accounts for 6% mortality of all cases admitted to health institutions
Diarrhoea diseases are the fourth leading cause of death in children under five years of age in Kenya and
accounts for 4% of all outpatient cases.
AIDS is a growing menace. The HIV -positive population is estimated at I 27m in 1996 -it was 448000 in
1990. AIDS was connected with about 80,000 deaths in 1996. 10 - 20% of HIV/AIDS occur in Nairobi.
Projected 1996 figures for male HIV related deaths in Nairobi total 56.000 and women 40.000.
“Empirical studies in Kenya have consistently shown that approximately 20% of patients seeking outpatient
care in both public and private institutions do suffer from some form of mental illness Majority of patients
present with physical symptoms which lead to misdiagnosis and numerous and often repeated wasteful and
expensive investigations and prescriptions. Despite acceptance that mental well being is essential to good
health, this apparent widespread psychiatric morbidity has not significantly influenced the planning of health
services in the health public service” 8
Legal System
The Kenya legal system is based on English common law, tribal law, and Islamic law, a judicial review in the
High Court and accepts compulsory ICJ jurisdiction with reservations.
Hospital beds number about 40.000 are several private hospitals, health centres and dispensaries. There was one
doctor per 7.410 inhabitants in 1993. Child malnutrition was estimated to be 22% in the period 1985-93.
The Constitution prohibits discrimination on the basis of a person's "race, tribe . place of origin or residence or
other local connection, political opinions, color or creed" However, the authorities do not effectively reinforce
all these provisions.
Women in the Legal System 32
Violence against women is a serious and widespread problem. The number of rapes reported to police has
increased from 1.274 in 1993 to 1.455 in 1995 and 1.020 in the first 6 months of 1996. Figures on assaults on
women and girls rose from 4.580 in 1994 to 4.889 in 1995 and 3.674 in the first half of the 1996. The available
statistics probably under report the number of incidents, however, since social mores deter women from going
outside their families or ethnic groups to report sexual abuse.
The Government condemns violence against women, and the law carries penalties of upto life imprisonment for
rape, however, the rate of persecution remains low because of cultural inhibitions against publicly discussing
sex, the fear of retribution, the disinclination of police to intervene in domestic disputes, and the unavailability
of doctors who might otherwise provide the necessary evidence for conviction. Furthermore, wife beating is
prevalent and largely condoned by much of the Kenyan society.
Traditional culture permits a man to discipline his wife by physical means and is ambivalent about the
seriousness of spousal rape. It also permits a man to have more than one wife (polygamy). Men are also
expected to pay ‘dowry’ i.e. payment in money or cows to future in-laws, in exchange for their daughter. This
practice gives men permission to treat their wives as they wish, often reminding them that they (wives), belong
to the man and his family.
Women experience a wide range of discriminatory practices, limiting their political and economic rights and
relegating them to second class citizenship.
The Constitution extends equal protection rights and freedoms to men and women, but long lacked a specific
prohibition of discrimination on grounds of gender.
Constitutional provisions continue to discriminate against women by allowing men, but not women, to
automatically bequeath citizenship to their children. While the Government has ratified international
conventions on women's rights, it has not passed domestic enabling legislation. The task force on laws relating

to women, established by the Attorney General in 1993 has yet to make its report.
Women continue to face both legal and actual discrimination in other areas. For example, a woman is legally
required to obtain the consent of her husband or father before obtaining a national identify card or a passport.
In practice, a woman must also have her husband's or father's approval to secure a bank loan.
According to a pension law, a widow loses her work pension upon remarriage, whereas a man does not.
The Law of Succession which governs inheritance rights provides for equal consideration of male and female
children. In practice, most inheritance problems do not come before the courts. Women are often excluded from
inheritance rights or given smaller shares then male claimants. A widow cannot be the sole administrator of her
husband's estate unless she has her children's consent.
Child rape and molestation are rapidly growing problems. There are frequent press reports of rape of young
girls, with rapists often middle aged or older. Legally, a man does not “not rape” a girl under fourteen, if he
has sexual intercourse with her against her will; he commits the lesser offence of “defilement”. The penalty
for the felony of rape can be life imprisonment, while for defilement upto five years imprisonment.
Values and Beliefs32
Kenya culturally has a mixture of indigenous traditional and modem values and beliefs, brought about by
western influence through Christianity and urbanisation, and tribal beliefs and practises.
Most tribal beliefs and values have some common themes e.g. patriachism. This manifests itself through the
supremacy of the male. Sons are important to the family because they perpetuate the family name and inherit
any family property or wealth. Traditionally daughter’s arc useful to their families as future investment i.e.
brought in cows/money from potential in-laws.
Another common theme within most tribal beliefs and values is the low status of women. Discrimination begins
al the earliest stages within the family and preference for sons is the norm. Often, even if a girl is desired, she is
seen as less valuable than a boy and consequently she deserves less investment from family resources, and often
seen as somebody who will only be valuable to future in-laws. She is given differential treatment in her
education, healthcare, work options and general care.
16

5.2 Nairobi
Nairobi, the capital of Kenya located in the centre of the country, hosted the Third World Women's
Conference held in 1985.
The population of Nairobi is estimated to be 1,346,000 million. Population growth has been exacerbated by
rural-urban migration, causing an alarming effect on its services. More recently, high birth rate has become the
most important factor, with the population growth of Nairobi having been estimated to be 7% per annum. Over
half of the population comprises of children under the age of fifteen. 16
One prediction estimates that Nairobi will be a mega-city of 15million by 2021. 34
Economic Survival
Formal employment i.e. employed in private and public sector, is still a significant source of employment, but
informal self- employment is growing at a more rapid rate. Informal self -employment in Nairobi grew by 27.7
% annually between 1980 and 1984. whereas formal waged employment grew by 18 % annually during the
same period It is now estimated that informal employment is growing at 40 - 60 per cent annually. 9
By 1990. it was estimated that 110.347 people were engaged in some sort of informal sector activity.
Informal employment i.e. retailing, otherwise known as hawking, is an important source of income in Nairobi
and is largely a response to harsh urban socio-economic environment. Most of the hawkers are women who
trade in perishable goods, i.e. vegetables and fruit as well as sweets, cigarettes, charcoal, cooked food. fish, meat
and soft drinks. Hawking plays a central economic role in a significant number of households in Nairobi
Overall, there arc an estimated 40.000 small businesses in Nairobi. There is no doubt the significance of the
sector in terms of providing employment at low cost and in generating an economic output which contributes to
the economy of Nairobi as a whole. 9
Unemployment rate in Nairobi, is estimated to be at 35% (1994 est) 32
17

6. FINDINGS
6.1 Literature Search: Women Mental Health and Urbanisation
"Since time memorial, women have been drawers of water, hewers of wood, labourers, preparers of
food, bearers of children, educators, health care providers, producers and decision makers. There is
now a growing recognition and concern that the stresses imposed on women affects their physical,
emotional and mental well-being”27
And for those women in the midst of urbanisation, their mental and physical welfare situation is even
bleaker. Real life cases of women in this environment, reflects their struggle in a quagmire of socio-
cultural and socioeconomic pressures and changes, escalating their rates of mental health disorders i.e.
depression and anxiety.
So far, the highest mental health disorders brought about by urbanisation, are of women in Africa
at 22% whilst for men at 14% 21
The impact of this problem has diverse effects not only on women, but on children, the family unit, the
community and on economic productivity (with women being a major part of the work force). As
World Bank Development Report 1993 summarises:
“There is growing evidence from both developed and developing countries, that the prevalence of
common mental health disorders (depression and anxiety) among women is higher than that of men. A
large number of women are thus at risk of serious mental health problems which must be treated before
leading to irreversible nervous breakdowns. "
In spite of all the empirical evidence of women's mental health in urbanisation, women's mental health
issues continue to be neglected by national and international policy makers, thus highlighting the lack
of value and recognition of women as an important resource within society and in development 29
6.1.1 Opportunities for Women in Urbanisation
In many ways urbanisation offers a unique opportunity for women to change their lives and escape
some of the oppressive traditions of the past and of village life which has excluded them from
positions of control and stifled their initiative.
Living and working in the city offers women the prospect of education and self-development and the
prospect of learning new skills and of earning an income2
6.1.2 Barriers Facing Women in Urbanisation
The reality is however, many women face a host of socio-cultural and socio-economic problems,
highlighting the subordinate and extremely vulnerable position their have in society compared with
men.
14
Social discrimination makes it difficult for women to achieve mastery by direct action and assertion.
Inequities lead to legal, social and economic helplessness, dependency on others, chronically low self
esteem and low aspirations. In this emotional state, women experience loss of control, helplessness,
disempowerment, shame, guilt, anger, feelings of inadequacy and being overwhelmed by the
situations they find themselves existing in. 24
Many women therefore find themselves without sustainable coping skills that if they had

would make a significant difference in preventing or reducing physical and mental health
problems
6.1.3 High Risk Groups of Mental Health Disorders
Within the adult population, women between the ages of 15 and 49 appear to suffer around twice the
rates of mental disorders seen in men. There is also a particular peak of depression in women aged 30
to 45 years.
Young people, especially girls starting as young as 12 years of age. arc at the forefront of the effects
of urbanisation and arc particularly vulnerable to the effects of the rapid change, which infiltrates into
their lives through their families and their school and community environment.
Children with depressed mothers tend to have more behavioural problems than children of healthy
mothers who show no signs of depression. Mothers arc unable to work and have difficulties
parenting children, and arc vulnerable to related physical problems1
.
6.1.4 Social Support Systems
In addition to long term difficulties and life events, a lack of social support systems, has been even
more detrimental to women's mental health in urbanisation.
Social support systems are reducing within families due to the reduction of extended families for those
women who migrated from the rural areas, an increase in single parent families due to bad
relationships, deaths of spouses, post-natal depression due to poor relationship leading to inadequate
support. Yet families should be the anchoring point where women should be able to draw social
support. 10
18

6.2 Qualitative and Quantitative Analysis
The questionnaire was answered by 170 women living and or working within Nairobi City Centre
during the period of July/ August 1997
Seven focus group discussions, with upto six women in each group, consisting of those women w ho
had participated in completion of questionnaires, were held.
The following is the profile of those who participated in the overall study:
6.2.1 Profile of Participants
Age in years
18 -25 =21% 26-35 = 37%
36-44 -32% 45-55=10%
Status
Married = 52% Single = 42% Other e.g. Widow = 6%
Formal /Informal Education
High School = 30% University = 29% College e.g. secretarial = 18%
Other e.g. informal = 10% Polytechnic = 7% Primary = 6%
Occupation
Employed = 57% Self Employed = 14% Unemployed = 12%
In Education - 8% Homemaker = 5% Other = 4%
Those with Children
Yes = 5 2 % No = 48%
19

6.3 Sample Group Analysis
The 18-25 age groups made up about a three quarters of the study group. Majority of them, were open
to change and optimistic about their future. Their main focus was to prepare themselves for a better
future than their mothers or older female siblings had experienced, through education and developing
themselves before committing to a relationship or family. They saw a good education as enabling them
to have more choices about what to do with their lives, using it as a stepping stone to financial security
and emotional independence. These groups were mainly single, without children, and still living at
home with their parents or older relatives. Most were in full time education and or unemployed and
looking for jobs. A handful in the group, felt locked and resigned to the pressures of city life.
The 26 - 44 age groups were the majority in the overall study. Majority of the women in this age
group were employed full lime and or self employed. Few were full time homemakers or
unemployed. Most of these women had attended university, polytechnic and college. More than
half were married, the rest were single with a couple widowed. More than half of the women in
the group had children.
This group was enthusiastic, fully involved and supportive of the study, identifying fully with the
stresses brought about by a changing environment. They were eager to be involved in any change that
would help support them in dealing with the stresses faced in the work place, homes and in the
community.
The 45 - 55 age groups were the minority and appeared reluctant to participate in the study. The few
who did participate reflected cynicism about the purpose of the study and its benefits. They reflected
resignation and acceptance of their lives in the city. Majority of women in this group had finished their
education at primary or lower high school, with some having had secretarial training or informal
education. Overall, a couple reflected a need for change and willingness to invest in change.
20

6.4 Mental Health Diagnosis (SRQ-20)
Disorder Absent = 62% i.e. 106 in sample group
Disorder Present = 38 % i.e. 64 in sample group
The most severe cases were between the ages of 30 - 45 years.
6.4.1 Symptoms Monitored and Experienced
The 38 % suffering from mental health disorders experienced the following
symptoms during the month of June 1997.
Decreased Energy Factors:
 Found decision-making hard.
 Had lost interest in things (generally).
 Were easily tired.
 Found it difficult to enjoy daily activities.
 Daily work was suffering.
 Fell constantly tired.
Somatic Symptoms Factors
 Suffered headaches.
 Slept badly.
 Had a poor appetite.
 Had experienced stomach ‘apprehension’.
 Had poor digestion.
 Had shaky hands.
Depression and Anxiety Factors
 Felt nervous, tense or worried.
 Were unhappy with self/ life.
 Were easily frightened.
 Felt weepy.
 Felt worthless.
 Felt suicidal.
 Felt useless to the community
21

6. 5 Service Providers Feedback and Findings
The service providers interviewed were mainly health professionals and those local NGOs
involved in providing support. The researcher team and consultant reported the following from
recorded, interviews
6.5.1 Health Professionals on Mental Health
Majority of people suffering from mental health disorders arc not in touch with the health services
but those who are tend to present with a variety of superficial physical symptoms, caused by their
underlying mental state.
Lack of understanding of mental health disorders by the public health professionals. This has
tended to reflect a false picture of people suffering from ill mental health.
Most women are treated by male practitioners, making it difficult for them to disclose their
stresses at both a physiological and social level. This is due to the male-female power dynamics
already existing between the two.
Evidence of ill mental health in Kenya, is reflected in the government's Health Policy Framework
which highlights the rising numbers suffering from ill mental health, however ill mental health is
not a priority and public health continues to focus on sexually transmitted diseases and other
illnesses due to resources. 8
Most people suffering from ill mental health go to the local dispensary when the illness has
reached an acute stage. Eventually the patient will sec a GP, who will then refer the patient to a
psychiatrist.
“On seeing them once or twice, they disappear into the community and I never see them
again, we (the public: system), lack an outreach component, and we are already
overstretched
Outreach for these women would he a good way of providing support for those
women suffering in the community.”
Depression is a very common presentation. This has also been noticed in younger women, and it is
growing i.e. upper primary and lower secondary school (12 to 18 year olds). This is mainly due to
pressure from parents and other stresses in the home and in the community.
Post natal depression is very common, due to the woman's mental state before and after the period
of giving birth.
6 5 2 Accessibility of Local Non-Government Organisations (NGOs) in Nairobi
At the time of the study there were:
NGOs whose objectives arc to provide a service for women in Kenya were at 40. This
information is registered with the National Council for NGOs; a self regulatory non-partisan
body, comprising all NGOs registered under the NGOs Co-ordination Act of 1990 in Kenya.
Of the registered NGOs. 28 were urban focused, seven of which had been disbanded but were still
on the books, leaving 21 still registered.

Of the 21 registered NGOs, were found in the telephone directory.
Researchers expressed the difficulty in knowing what the existing services for women arc.
because of lack of information and the tedious process involved in accessing whatever little
information there was available.
6.5. 2. 1 Dissemination of Information on Service Provision
It is not the norm for NGOs to disseminate information on their services to the public cither
through papers, radio or leaflets in public places where their target groups are likely to be.
Reasons given for this was money - costly. Most of the organisations relied on word of mouth to
inform their target group.
Most of the local NGOs worked in isolation. There was a clear lack of linkage and sharing of
information with other NGOs. Reasons given for lack of networking or linking with other NGOs
were mainly due to: funding disputes: disagreements on how service provision should be
implemented: disagreements on individual motivations versus the organsiations objectives and
tribalism.
6.5.2.2 NGOs in Women's Mental Health in Nairobi
Nil (0) NGOs worked directly with women and communities on the issues of mental health
education and prevention, yet all those interviewed were able to quote examples of women in
their communities and or friends who arc victims of ill mental health.
One of the NGOs interviewed focused on women's physiological/physical well being and
research. The NGO is run by volunteer doctors. They were not involved in any activities in the
area of women's mental health
One of the NGOs interviewed, focused on empowering women already in positions of influence,
with the aim of affecting policy making decisions in issues concerning women.
One other NGO (regional) focused on family planning and reproductive health, through working
with both men and women in management positions, who would filter down their learning to the
various communities
Another regional NGO focused on providing for at which home economists in Africa deliberate
on issues affecting the profession and families. Mental health was an issue that this NGO had been
considering in their programme plans.
Two other NGOs dealt with both men and women, providing a counselling service from a
counselling centre. One had a religious focus.
All the NGOs interviewed expressed keen interest in linking in with any future project that
might arise from this study.
The three church representatives interviewed, agreed that they were often faced with people
suffering form mental health disorders and were willing to be a part of sharing any mental
health education programme that would help others.

6.6 Focus Group /Questionnaires Feedback
The focus groups participants ranged from 18-49 years of age. Care was taken to select only
those women who had completed the questionnaire and were willing to participate in the study
All the women interviewed found the conversations to be pleasant and relevant. Several of them
expressed the view that this was an occasion for them to talk openly about matters they
experienced daily, in isolation. They found it a relief to know that they were not on their own In
general they disclosed their concerns without feeling threatened and on occasion becoming
emotional while narrating their stories. They said they found the process of being and sharing with
each other, empowering and very supportive.
These were the major issues raised by the focus groups and from the rest of the questionnaire.
Researchers reported the following key findings:
6. 6. 1 Socio-Cultural and Socio-Economic
There is pressure for women to be in a 'committed' heterosexual relationship by a
‘certain age’.
There are expectations and pressures from the community for women to have children by a
certain age and be within a committed relationship.
Women without a husband/ partner face covert and overt pressure from the community at
large and in many cases, from the woman's family of origin.
A single woman who has children out of marriage tends to struggle more with coping
effectively financially and emotionally as a single woman and parent.
54 percent of women feel responsible for the welfare and discipline of their children. Most
women worry about their children getting involved in drugs, alcohol, crime, contracting HIV,
and in the case of daughters, sexual abuse. Having overall responsibility for the welfare of the
children is extremely stressful to women, because they feel confused about what parenting
approach to take. The traditional approach most women grew up with proves to be non-
effective and detrimental to the relationship with their children, given the environment their
children arc living in.
Women are often blamed and used as scapegoats by family and the community for any
adverse symptoms in their children at any age, and in their family.
Women arc expected to straddle the traditional role of a woman i.e. to bear children, look for
and prepare daily meals, nurture the family ensuring good health, and look after the home.
Additionally women arc also expected to go out to work, where they arc faced with work
discrimination and at the end of the month, juggles whatever money they have to pay the
monthly bills.
Most women feel some of the tribal traditions they arc expected to adhere to by society, have lost

the original meaning in the current environment and arc being used by many men to further
oppress them e.g.
bride price - originally a token, paid to the bride's family by the groom's family, showing
appreciation and a promise to look after their daughter
polygamy - permission for the man to have more than one wife. Women say:
"Just because a man has paid cows to my family, he feels he has got the
right to treat me how he wants, like I am his thing.”
“Many men feel that it is their right to lime as many wives mistresses as
they want... you dare not question. Just be happy that you have got a
husband. “
6.6.1.1 Family Relations
Expectations for women to behave in a way defined by the in-laws, tends to create friction in the
lives of those women who are married. This then seeps into the woman's own relationship and
family.
Many relationships arc volatile and/ or unhappy, due to the husband's dependency on alcohol,
other women, drugs, violence, unemployment, finances etc. On the whole, relationships are
difficult to manage due to internal and external pressures the family face daily. There arc many
women who opt to stay in a volatile and unhappy relationship, viewing it as the easier option to
being single. However the number of single women is on the increase, due to emotionally and
physically abusive experiences in past relationships.
Women say:
"Wife beating is so serious in many relationships, and unless you stop it, you
will be beaten to death in front of your own children".
"It's always our 'fault', when anything goes wrong in the family or in the home”.
6.6.1.2 Economic/ Political Environment
90 per cent of women identify the economic environment as harsh. This is mainly due to the
discrimination and sexual harassment they face as women in the workplace. Male counterparts
earn more for the same job as women, and yet many women feel responsible for paying the
household bills with the little money they earn. This leads to borrowing money which often leads
to debt.
Some women who share the economic burden with a husband/ partner, face a treble
burden because regardless of the two incomes, the woman is left to manage all the bills.
An issue that often leads to domestic violence or emotional abuse, if the woman dares to
protest.
"I have no finances to take the children to school, yet my husband is working as well. So
what do I do?"
"Unemployment... any job will do, no matter how well educated you are and regardless
of how little they are paying you ..."

6. 6 1.3 Violence
90 per cent of women in the groups have experienced some or all of the following:
Sexual abuse, domestic violence, emotional abuse, street violence and
sexual harassment and discrimination
The extents of violence women say, is largely hidden and widely denied by women, victims and
the community at large.
Women feel unsafe and see themselves as easy targets, with little protection from the law
"I was walking down the street coming from work, close to Serena. Out of the blue this wan
grabbed me from the back and started to choke me. I was so scared. I struggled and ran away.
There were people watching. Nobody came to help me”.
"You go to the police and they will harass you even wore. Shauri yako tu (it is your problem),
they tell you.
6. 6.1.4 Life Events
48 per cent of women viewed illness and deaths as contributing to their ill mental health
disorders. Women are faced with the responsibility of the welfare of their families as well as
nurturing the survivors of family deaths. There is little concern regarding their own welfare.
This entails a lot of anxiety. They feel their social and socio-cultural roles, puts them at risk
of more personal losses. They see themselves as especially vulnerable and emotionally
reactive to these stressors
There is acknowledgement of the lack of support in coping with traumatic life events, e.g.
deaths, unemployment, sexual and emotion abuse, post-natal depression, discrimination,
miscarriage etc. Some women feel they cannot express their feelings to their families and
friends when these events happen in their lives.
The feelings of shame, guilt, anger, failure, and sadness, leave them feeling isolated and
alone. One woman says:
"Who can I talk to who would understand? So, I pray and keep quiet.”
6.6.1.4 Legal Rights
90 per cent of women were not aware of any legal rights they could exercise. None of the women
in the sample group had used the police as a means of support. There were strong feelings about
the police being some of the worst offenders to women.
26

6.6.1.5 Mental Health Awareness and Attitudes
Most of the women repeatedly reported suffering from diverse ailments, many of which are of
psychosomatic origin, but only seek help when the problem becomes serious, at which point they
go to the clinic. Treatment at the clinic is curative. Most women are unaware of the relationship
between daily stresses, and the psychosomatic ailments they experience.
There are other priorities that prevent women from paying attention to their mental health
problems. Moreover, if problems relate to mental health, the social and cultural environment
results in them being concealed as much as possible, and only recognised when severe
breakdowns occur.
Some of the women have relatives or know of families where a member of the family has
experienced severe mental health breakdowns. When this happens, the sufferers are taken into
mental institutions; the only place where sufferers go can go, despite the institutions being
overcrowded. There are very limited places those suffering mental health disorders can go. One
woman says:
“You can see these people (sufferers) roaming around on the streets of Nairobi
from Mathare”
Due to lack of mental health services, many families affected by mental health disorders are
forced to move back to the rural areas, where they are looked after by relatives.
Because mental illness is considered a 'taboo', a large number of sufferer’s are either hidden away
by their families, and/ or the illness is not spoken about, because of the shame/embarrassment
attached to mental illness. One woman tells her sad story:
"People did not want me to talk about my situation. They found it too embarrassing and shameful.
I was discouraged from talking about it within the community, church, friends, etc. They wanted
me to keep my children hidden away. My husband did not want to hear about it, and this brought
a rift in our family. The illness brought a lot of grief and pain to my family. I was then advised to
put them into Mathare (a mental institution). 1 did. They came out worse than before. Next, I had
no choice but to go private, where one psychiatrist told me that I was wasting my money on my
children. I struggled on my own, looking for medicine, which is very expensive ..."
6. 6.1.6 Attitudes On Personal Welfare
Low self esteem was highlighted, which affected the way women handled their stresses.
"We (women) are covering up a lot. You see someone telling you that they did not eat last
night, and they are laughing...” The groups acknowledged that they face a lot of stress, but
felt it was a 'normal' state of their lives. "There is so much we are hiding, but what can we
do? We do not have a choice…”
6. 6.1.7 Recreational Activities
A small percentage of women are involved in activities promoting their own well being. For most,
thoughts of ‘well-being’, enjoying activities or relationships, was seldom mentioned. Most felt
they did not feel entitled to such ‘luxury’, as their time was taken up by managing their already
complex lives. Developing recreational activities was thus difficult due to lack of time and money.

6. 6.1.8 Sources of Support
Women get their support from a range of sources Most speak to friends and relatives, and a few
to neighbours and some to doctors, others spoke to nobody
11 percent of women used their family as a means of support.
20 percent who keep their problems to themselves. One can only sadly conclude that many
women have lost trust and faith in using the family unit for support, due to the lack of support and
pressures experienced from their immediate and extended families.
18 percent of women find support in their female friends, who they feel able to share experiences
with, consequently drawing support from shared experiences.
17 percent of women attend church as a means of support, however talked about how little they
disclosed their inner turmoil to the church group.
None use the legal system i.e. the police and lawyers/ solicitors etc.
7 percent use NGOs, whilst 65 percent of the women where not aware of the existence of any
NGOs who could help them.
A number of women feel that some local NGOs provide help with an underlying religious theme
and feel they would rather not use this support, because of the underlying religious pressures.
There was a general cynicism about the function of local NGOs expressed by the few who have
interacted with them. Many women asked:
"Which people are they actually helping”?
There were concerns regarding service charges requested by NGOs, which they could not afford.
A few had joined small informal groups (office and community based) that helped them
financially.
9 per cent used ‘other’ means e.g. writing letters to an agony aunt, prayer, counselling. Some
women used alcohol to cope with their stresses.
28

7. CONCLUSION
This study, is ample evidence reflecting the reality of women in Nairobi Kenya, as high risk and
suffering' from mental health disorders, often going undetected and untreated, recognised by
health professionals only when the disorders reach an acute and irreversible stage. The study
highlights the origins of mental health disorders in women, as coming from the continuous
challenges and demands brought by urbanisation, in addition to socio-cultural and socio-economic
pressures. Their status as women too, presents additional pressures.
The high risk groups and sufferers are mainly women between the ages of 26 - 44 years old
working and or living in Nairobi. Young girls as early as twelve years old are also high risk, due
to being caught in the midst of the 'new ways' brought by urbanisation, and the 'traditional ways
demanded of them by their families and the wider community.
7.1 Summary
The report highlights the issues of mental health disorders in women as a problem in Nairobi and
the current mental health and related support services as having infrastructures that are not
meeting the changing needs of women's mental welfare in Nairobi. Health service providers
continue to use outdated interventions, as opposed to empowering women and communities with
sustainable coping and preventative life skills that would enable them to take control of their
mental welfare
Failure for organisations to identify those groups vulnerable to ill mental health, develop systems
to deal with women's mental health needs, has also led to inequality within service provision in
both the public health service and within current support services for women, consequently
women's health issues continue to be neglected and ignored, reflected in the public health service.
Family support systems are also on the decrease, so those women and families affected by mental
health disorders have got little or no choice about where to go for help.
There are real serious mental health issues affecting women and families in Nairobi that need
addressing, preferably using a different approach from the current health service provision.
Failure to deal with the issues in the study means that communities will continue to violate and
abuse women, break down the family unit and continue to perpetuate the stigma of ill mental
health, leaving the Kenyan women, families and communities, ignorant and dependant on the
system to determine their social and mental welfare.
It is crucial for these issues to be redressed from a human rights aspect as well as to enable those
women living and working in Nairobi move towards sustainable mental welfare.
29

8 RECOMMENDATIONS
"People cannot achieve their full potential unless they are able to take control of those things
which determine their health. This must apply equally to men and women.” 25
8.1 Health Professionals - Recommendations for Action
Non-medical interventions to cope with the mental health disorders i.e. support groups e.g. alcohol
and drug problems, post natal depression, family relationships, emotional and physical abuse. .
A focus on an emerging high risk group i.e. pre-teen and teenage girls, starting from twelve years
upwards.
To involve community leaders and groups e.g. church leaders, community groups, thus working
directly with individual communities and needs.
Outreach as a major component in reaching those affected by mental health disorders
8.2 Women in Sample Group - Recommendations For Action
Mental health education and awareness inclusive of all sections in the community.
This would help break the stigma associated with mental health disorders, and help the wider
community understand mental health issues. It would also help people understand how to identify
and prevent mental health disorders, before it becomes irreversible.
Places where women can draw support and share experiences with each other.
Women isolate themselves when they are under extreme stress for fear of recriminations for
having 'failed' and for fear of not being understood. Sharing experiences during the study proved
to women how empowering sharing their experiences was, because of the common ground they
shared and how supportive women were about the various stresses they faced as women.
Social and Life Skills training and awareness to help those under stress cope with the practical
concerns faced daily e.g. keeping yourself safe, dealing with loneliness, parenting skills, relation
ships, unemployment, managing money, communication, career development and guidance, job
skills training etc.
Information and awareness on groups/ agencies within the community, that women can draw on to
help them cope at a legal, financial, and or social-cultural level e.g. domestic violence, rape, street
violence, small business enterprise, finances/ loans for women, legal rights, housing, career
development etc
30

8.3 Development Consultants - Recommendations for Action
"People cannot achieve their full potential unless they are able to take control of those things
which determine their health. This must apply equally to men and women”.25
Given the standards of world health, identified by the ALMA ATA 4 documents (see
appendix...) and the findings from this report the following is recommended:
8.3.1 Proposed Project
An urban focused project managed by women, that will work in partnerships with community
based organisations, local institutions, local NGOs, private and government health workers and
individuals, sharing resources, information, education and life experiences.
The proposed project aims to be inclusive, recognising that men need to make an
equal contribution to the development of the service.
8.3.1.1 Project Description
Promote the self reliance and mental well being of women, families and those urban
communities, affected by mental health disorders, through providing a comprehensive
support service that will aim to:
 Build and promote community, individual and family mental welfare
support/interventions.
 Create and promote social awareness on mental health issues within the urban
communities
 Raise the profile, self esteem and opportunities for women through access to information
and life skills development.
 Advocate and lobby on behalf of women, on issues affecting women's mental welfare.
 Research and Development on women, family and mental welfare issues
8.3.1.2 Target Group
The focus to be women between the ages of 26 - 45 years, working and or living within Nairobi
city. This however, is only a starting point.
8.3.1.3 Justification for Target group
In addition to everyday stresses, women living and working in Nairobi are faced with additional
stresses from within the workplace.
Because the economic environment in Nairobi is largely male oriented, the socio-cultural and
socio-economic behavior and altitudes towards women in the work place, is largely negative
Working women face continuous sexual harassment and discrimination, as well as being

exposed to physical violence and emotional abuse, not only in the workplace, but to and from
work on the streets,
In the formal work place, women are promoted more slowly than men and get less pay, often
bearing the blunt of job retrenchments. In the informal sector, where over half the hawkers are
women under 32 years of age and 30% are aged between 33 and 40 years of age and married and
with children (sec 5.2) female headed households almost always earn less than male counterparts.
This disparity can be explained by the fact that males have a better chance of obtaining
employment in the formal and or informal sector.
During a working day, women continue to juggle their family and work lives, often taking their
young children with them to their places of work (in the informal sector), and those in the formal
sector, have to look for childcare whilst at work, and or take their children to work with them (a
rare situation in the private sector). Family shopping is carried out mainly during lunch breaks
during work time, or after work. In addition to all this, women take care of any family crises that
may arise during the day or the evening before e.g. take the children to hospital, look for new
baby-sitters, visit and look after a widowed or sick relative etc.
This group of women also face overt and covert pressure from the community, mainly for
breaking the traditional role of women where they are beginning to make choices for themselves
e.g. to marry or not, have children or not or when, pursue career, have financial independence etc.
At the end of a working day, this group of women then turns to fulfilling their roles as mothers,
wives, single women, careers, and for many, manage the family finances at the end of each month
32

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