Exploring Low Uptake of Skilled Delivery Services and Postpartum Family Planning Services among Women Living in Western Kenya

Author(s): Naanyu V, Baliddawa J, Peca E, Karfakis J, Nyagoha N, Koech B

Year: 2011

Abstract:

Background. Kenya has relatively poor maternal and infant health outcomes. Despite the fact that 92 percent of Kenyan women receive antenatal care (ANC), the 2008-2009 Kenya Demographic and Health Survey indicates that only 44 percent of births in Kenya were attended by a health care professional and 44 percent of deliveries occurred in health facilities. Moreover, 26 percent of women have an unmet need for family planning (FP) and the decline in total fertility rate has stalled at about 4.6 since 1995. Little is known about how women choose where to deliver their children and how they arrive at their postpartum FP decisions. This study explores the complex confluence of factors that influence delivery and FP decision making.

Methods. A total of 20 focus group discussions (FGDs) were conducted at two sites in western Kenya — one rural site and one urban — to explore delivery choices and postpartum FP. Ten FGDs at each site were conducted with the following groups: health care providers from the formal sector, traditional birth attendants, women who attended at least four ANC visits and gave birth at home, and women who attended at least four ANC visits and gave birth in a health care facility. Three in-depth interviews were conducted at each site with a combination of women who gave birth in a facility and at home. All discussions were recorded. Data were analyzed for thematic content by four research team members.

Results. Decisions pertaining to where women give birth are influenced by socioeconomic factors, cultural practices, fear of HIV testing at the hospital, quality of service provided, access to facilities, and stigma surrounding health facilities, among other factors. Findings illustrate that FP practices are determined by spousal and extended family support, literacy and access to accurate information about FP, fear of side effects, costs of FP methods, and religion. Our findings suggest changes in health care policy, service provision, better information dissemination, education campaigns, and respect for socio-cultural practices will encourage uptake of facility-based deliveries and postpartum FP practices.