Abstract
Maternal and newborn mortality rates are high in peri-urban areas in cities in Kenya, yet little is known about what drives women's decisions on where to deliver. This study aimed at understanding women's preferences on place of childbirth and how sociodemographic factors shape these preferences. This study used a Discrete Choice Experiment (DCE) to quantify the relative importance of attributes on women's choice of place of childbirth within a peri-urban setting in Nairobi, Kenya. Participants were women aged 18-49 years, who had delivered at six health facilities. The DCE consisted of six attributes: cleanliness, availability of medical equipment and drug supplies, attitude of healthcare worker, cost of delivery services, the quality of clinical services, distance and an opt-out alternative. Each woman received eight questions. A conditional logit model established the relative strength of preferences. A mixed logit model was used to assess how women's preferences for selected attributes changed based on their sociodemographic characteristics. 411 women participated in the Discrete Choice Experiment, a response rate of 97.6% and completed 20,080 choice tasks. Health facility cleanliness was found to have the strongest association with choice of health facility (β = 1.488 p<0.001) followed respectively by medical equipment and supplies availability (β = 1.435 p<0.001). The opt-out alternative (β = 1.424 p<0.001) came third. The attitude of the health care workers (β = 1.347, p<0.001), quality of clinical services (β = 0.385, p<0.001), distance (β = 0.339, p<0.001) and cost (β = 0.0002 p<0.001) were ranked 4th to 7th respectively. Women who were younger and were the main income earners having a stronger preference for clean health facilities. Older married women had stronger preference for availability of medical equipment and kind healthcare workers. Women preferred both technical and process indicators of quality of care. DCE's can lead to the development of person-centered strategies that take into account the preferences of women to improve maternal and newborn health outcomes.
Highlights
In 2015, an estimated 303,000 women were reported to have died in the developing world out of maternal causes [1]
Discrete Choice Experiment (DCE)’s can lead to the development of person-centered strategies that take into account the preferences of women to improve maternal and newborn health outcomes
This is a key reason behind Sustainable Development Goal 3 (SDG3), which aims to reduce the global maternal mortality ratio (MMR) to 70 for every 100,000 live births by 2030 [2]
Summary
In 2015, an estimated 303,000 women were reported to have died in the developing world out of maternal causes [1]. Most maternal deaths (99%) occur in developing countries with over half of these deaths occurring in sub-Saharan Africa [1]. This is a key reason behind Sustainable Development Goal 3 (SDG3), which aims to reduce the global maternal mortality ratio (MMR) to 70 for every 100,000 live births by 2030 [2]. The ratios are high across peri-urban informal settings. Health centers and dispensaries received direct reimbursements through the hospital Sector Services Fund to an amount of (2500 Ksh /25$). Women continued to pay incidental charges which varied by facility and presumably were for supplies that were not part of the hospital reimbursement package from the government
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