A Qualitative Exploration of Access and Utilization of Focused Antenatal Care among Pastoral Community in North Eastern Kenya

Abstract

Background: Ministry of Health Kenya has adopted new guidelines for FANC services emphasizing on four antenatal care visits, birth planning and emergency preparedness. In North eastern Kenya predominately occupied by Somali pastoralist Communities only 37% of women of reproductive age receive ANC service at least 4 times during pregnancy, which is considerably lower than the national rate of 58%. There is limited utilization of healthcare services among nomadic pastoralist compared to general population, this is due to several constraints stemming from their migratory way of life, poor social services and spatial disparities. Limited studies have adopted qualitative approaches to explore access and utilization FANC among pastoralist communities. The study explored access and utilization of FANC service among pastoralist community of North Eastern Kenya.
 Methodology: The study is an exploratory qualitative study, using a purposive sampling method forty eight women who give birth two years prior to the study were selected, sixteen male partners and three ANC providers. Data was collected using FGDs and KIIs and analyzed thematically.
 Results: There is low utilization of FANC among pastoralist communities, the proportion of respondents who had utilized was 83.3% but only few 39.6% had utilized the required four visits (FANC). There is delayed initiation of uptake of FANC services where majority respondents 55.0% had attended ANC in their second trimester while only 17.5% had utilized in their first trimester as recommended. Barrier that hampered FANC uptake are: long distance to health centre, transport cost, low level of FANC knowledge, TBAs practice, low income and harmful cultural practices. Major facilitators identified are free FANC charges, good attitude of a care giver and fear of pregnancy complication. Access challenges range from inadequate infrastructure, lack of skilled health attendants and logistical constraints to harmful cultural practices.
 Conclusion: There is need to reduce travelling time to the health facility by conducting regular outreach services targeting nomads with no near facility, improve culturally sensitive FANC to increase accessibility, involving all health stakeholders and community representatives to increase cultural acceptability and also help priorities policies that increases FANC service uptake.