Intimate Partner Violence, Motherhood, and Mental Health: Examining the Impact on Survivors' Mental Health in Informal Settlements of Nairobi, Kenya

Background and purpose: Intimate partner violence (IPV) is a serious global public health threat, disproportionately affecting women in low- and middle-income countries. In Kenya, women living in informal settlements are particularly vulnerable to IPV, with a 2012 study revealing that 85% of them have experienced IPV in their lifetime. These populations are more likely to experience the syndemic of IPV and poor mental health outcomes (e.g., depressive disorders and psychological distress), because of their precarious living situation, limited access to mental health services due to geographical distance, and unaffordable service fees. Yet, there is a paucity of literature focusing on mother’s mental health as they endeavor to support their families while experiencing IPV. This qualitative study presents the experiences of IPV-exposed mothers in accessing mental health services, as reported by survivors of IPV, clinic staff, and community health volunteers (CHVs).

Methods: Using the social ecological model of resilience, the study examines women’s experiences accessing mental health services while navigating the challenges posed by IPV, motherhood, and poverty in informal settlements at micro-, mezzo-, and macro-levels. Study data was drawn from in-depth, semi-structured interviews collected as part of an ongoing study exploring potential facilitators and barriers to IPV and mental health screening and intervention in healthcare settings in Kibera and Mathare, two informal settlements in Nairobi, Kenya. Participants in this study included 36 survivors of IPV, 30 clinic staff, and 24 CHVs. The interviews were conducted by 16 members of the community-based research team, audio recorded, transcribed verbatim, and then translated into English. Two research team members reviewed all transcripts and generated a draft codebook focused on facilitators and barriers to IPV and mental health screening and intervention. Five team members subsequently used this codebook to code transcripts.

Results: Results of the qualitative analysis indicated the emergence of four core findings: (1) Maternal efficacy and challenges of motherhood in the context of IPV: Illustrate the socio-cultural expectation of mothers and continued disinvestment from the government, (2) Mental health impacts on IPV-exposed mothers: Highlights the additional stress from the lack of paternal support and fear of stigma and victimization from the community, (3) Resilience in caregiving and surviving IPV: Details the role of social supports and utilization of services, (4) Negotiating between the needs and resources to care for themselves and their children.

Conclusions and implications: The findings highlight the critical importance of understanding the unique challenges specific to women's parenting and maintaining their safety and mental health while navigating IPV and poverty in informal settlements. This study raises key implications for grounding research in the lived experiences of IPV-exposed mothers and their service providers to address the socio-political and environmental forces that create vulnerability for women and their access to mental health services. By combining the knowledge from IPV-exposed mothers and their service providers, social workers can co-create solutions to better alleviate the stress and psychological strain mothers face and equip them with skills to support their children while maintaining their own mental health and well-being.