Replicating the Kenyan Case: A Reassessment of Obstetric and Gynaecological Medicine Challenges,

The original Kenyan case study outlined systemic challenges within the country's obstetric and gynaecological medicine sector. This replication study sought to verify the persistence and evolution of these challenges. The purpose was to reassess the key challenges in obstetric and gynaecological medicine in Kenya, as identified in the original study, to determine their contemporary relevance and any shifts in their nature. The objective was to produce an updated evidence base for strategic planning. This qualitative replication study used a similar case study design. Data were collected via semi-structured interviews with a purposive sample of healthcare professionals and through analysis of policy and facility audit documents. Thematic analysis identified persistent and emergent themes. The core challenges of human resource shortages, essential commodity stock-outs, and financial barriers to access remain entrenched. A majority of clinicians reported stock-outs of essential uterotonics as a weekly or daily occurrence. A new, prominent theme of medical-legal anxiety influencing clinical decision-making was identified. Fundamental systemic challenges in Kenyan obstetric and gynaecological care persist with significant severity. The landscape is further complicated by emerging pressures, notably fear of litigation, which may indirectly affect service delivery and clinical practice. Immediate action is required to stabilise supply chains for life-saving commodities. Investment in training and retention of specialist staff must be accelerated. The development of clear national guidelines and legal safeguards to support clinicians in complex obstetric situations is urgently needed. Replication study, Kenya, Obstetrics, Gynaecology, Health systems, Maternal health, Medical-legal issues This study provides a contemporary verification of persistent systemic challenges and identifies a new, critical factor of medical-legal anxiety within Kenyan obstetric and gynaecological care, offering an updated evidence base for policymakers and health planners.