Navigating the Informal Health Sector: A Review of Maternal and Reproductive Medicine in Urban Kenya

In urban Kenya, a substantial portion of maternal and reproductive healthcare is delivered by the informal health sector. This includes unlicensed chemists, traditional birth attendants, and informal drug vendors operating outside formal regulatory frameworks, creating a complex landscape for healthcare delivery. This review aims to synthesise existing knowledge on the role, utilisation, and characteristics of the informal health sector in providing maternal and reproductive medicine in urban Kenya. It seeks to identify key drivers of use, patterns of care provision, and implications for health outcomes. A narrative review of published and grey literature was conducted. Sources included peer-reviewed journal articles, reports from non-governmental organisations, and relevant policy documents. Thematic analysis was employed to identify consistent patterns and critical insights. The informal sector is a primary first point of contact for many, particularly for contraception and management of minor ailments. Its utilisation is driven by factors such as affordability, accessibility, and perceived privacy. However, the quality of care is variable, with documented instances of inappropriate practices, including the incorrect dispensing of antibiotics for reproductive tract infections. The informal health sector is an entrenched and pragmatic component of the urban Kenyan healthcare ecosystem for maternal and reproductive health. Its prevalence underscores gaps in the formal system but also presents significant challenges related to patient safety, regulation, and the potential for integration. Policy should shift towards engagement and pragmatic regulation rather than marginalisation. Potential initiatives include targeted training for informal providers, the development of clear referral pathways to formal services, and the exploration of supervised partnership models to enhance overall service quality and safety. informal health sector, maternal health, reproductive medicine, urban health, Kenya, healthcare access This review consolidates fragmented evidence to provide a structured overview for researchers and policymakers, elucidating the dual role of the informal sector as both a critical access point and a source of potential risk in urban maternal healthcare.