Household characteristics affecting where mothers deliver in rural Kenya

Abstract

Data from a household survey were used to analyse the distribution of newborn deliveries in a rural area of Kenya. It was found that 52% of deliveries occurred at home or with traditional birth attendants. Using regression techniques, the most significant predictors of choosing an informal delivery setting are the household's distance from the nearest maternity bed and whether a household member has insurance. The results suggest that travel time is an important barrier to access. Therefore, quality improvements at existing facilities may not result in greater use of modern sector delivery, particularly if improvements are partially offset by user fees.

A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context

“…We located few studies of high or moderate quality, and eight studies 19,35,36,41,43,45,48,49 had sample sizes of less than 500 women, restricting the ability to draw conclusions. In some instances, the population in need of health care was not identified accurately because data were collected for other purposes, such as the evaluation of child health; for example, in one study, the population was restricted to married women younger than 35 years with at least one child younger than 5 years.…”

“…12,29 Instead, determinants of delivering in a medical setting included education, age, obstetric risk measures, medical insurance, time to travel to site of care and openness to the outside world in Guatemala; 12 and education, region, availability of polyclinic in the community and timing of the birth in Tajikistan. 29 The low-quality studies tended to report either an association between higher economic status and increased use, 27,32,[42][43][44][45] or no difference with increasing wealth. 19,[46][47][48][49] Antenatal care in the first trimester Urban-rural differences Five studies, one of high quality and three of moderate quality, examined the effect of urban-rural residence on antenatal care during the first trimester of pregnancy (Table 3, available at: http://www.who.int/bulletin/volumes/ 85/10/06-035659/en/index.html).…”

Barriers to Antenatal Care in an Urban Community in the Gambia: An In-depth Qualitative Interview Study

“…Previous reports from throughout sub-Saharan Africa have recognized some of these barriers, but a number of these studies have been quantitative surveys. It is interesting to note that when a structured questionnaire 4,11,12,14,15 is used there is more emphasis on the practical barriers to attendance whereas the more open-ended, lessconstrained approach with a qualitative study 5,[6][7][8]10 enables the identification of additional and more complex barriers. During the first three months the barriers are almost entirely identified by qualitative studies.…”

“…Also cited were conflicting domestic demands, journey time and distance to the HC 10,4,12 . In addition the qualitative studies reported many more instances of poor relationships with the health staff, shame or humiliation if the documentation was not in place 7 , and an overriding suspicion that they were perceived as poor and uneducated 5 .…”

“…Throughout sub-Saharan Africa, in addition to social taboos, there is evidence that women are unsure of the purpose behind antenatal care 7 , probably due to a belief that childbearing represents a normal ‗bodily experience' rather than an illness 8 . Practical barriers to using antenatal care include remoteness from treatment facilities and costs [9][10][11] , a belief that attendance is necessary to obtain a document that permits delivery within the hospital 8 , and the attitude of health professionals [12][13][14][15] . The barriers to antenatal care remain unstudied in an urban context.…”