Provision and Use of Maternal Health Services among Urban Poor Women in Kenya: What Do We Know and What Can We Do?

Abstract

In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanization and an increasing proportion of urban dwellers living in slums and shanty towns, making it imperative to pay greater attention to the health problems of the urban poor. In particular, urgent efforts need to focus on maternal health. Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility-and individual-level data collected in the slums of Nairobi, Kenya to: (1) describe the provision of obstetric care in the Nairobi informal settlements; (2) describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and (3) draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services, a finding which supports the view that low-income urban residents in developing countries face significant obstacles in accessing health care. This study also shows that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low compared to Nairobi as a whole and, more importantly, compared to rural populations. Bivariate analyses show that household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. Finally, there is a strong linkage between use of antenatal care and place of delivery. The findings of this study call for urgent attention by Kenya's Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services.

Determinants of Time of Start of Prenatal Care and Number of Prenatal Care Visits During Pregnancy Among Nepalese Women

“…In this study, the proportion of women with no education was higher and among them majority (39%) had no prenatal care visits. This study confirms findings in other studies that women with higher parity are less likely to initiate prenatal care early or more likely to have less number of prenatal care visits [10,24,29]. Women with high parity might tend to rely on their experiences from previous pregnancies and therefore do not feel the need for prenatal check-ups [30,31].…”

“…This demonstrates that given the distribution of maternal health services, it is possible that women in rural setting can increase their use of these services. Apart from the infrastructure advantage of urban women, it is also possible that the rural-urban differences in PNC use seen in this study result from the difference in exposure to health information these groups [24]. The household socio-economic status (wealth index), occupational status and religion were observed to be associated with the timing of prenatal care.…”

Using community-based research to shape the design and delivery of maternal health services in Northern Nigeria

“…Other studies, in Burkina Faso, Kenya and Tanzania, as well as in Nigeria, have found an association between using antenatal care and delivering with a skilled birth attendant, [11][12][13][14][15] and one in Uganda that low quality maternity services were associated with low rates of antenatal visits. 16 Multivariate analysis in this study showed that accessibility and socioeconomic status had no influence on the likelihood of women of using antenatal services for their most recent pregnancy, as has also been found in both Burkina Faso and India.…”

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“…While in this study the use of MHS was found to be significantly associated with the level of autonomy, however, this finding is contrary to studies in Kenya [8]; Nepal [26] and Pakistan [9,27] reported that the use of MHS is similar among women irrespective of their level of freedom of movement, empowerment, and participatory decision making process at the family level. The Kenyan study advanced that cost of services rendered and transport were the underlying root causes for lower use of MHS [8,17]. Similarly, the Pakistani study underscored that generally women have freedom to go out of their matrimonial homes as part of social obligation within the family and neighbourhood structure and therefore not a valid measure for autonomy [9,27].…”

“…In order to measure female autonomy in the context of MHS, we have used three variables namely: a) income independence (having a paying job); b) participation in family level decision making process on health issues; and c) freedom to go out of her matrimonial home on health issues without the need to ask for permission from anybody. The influence of these variables on the use of MHS were well documented, however, research in countries with similar challenges on women empowerment and equality was reported to be unequivocal [8,9,17,18]. These studies suggested the need for more community based studies in order to provide better insights on the influence of these variables on MHS.…”