Abstract
BackgroundKenya’s high maternal mortality ratio can be partly explained by the low proportion of women delivering in health facilities attended by skilled birth attendants (SBAs). Many women continue to give birth at home attended by family members or traditional birth attendants (TBAs). This is particularly true for pastoralist women in Laikipia and Samburu counties, Kenya. This paper investigates the socio-demographic factors and cultural beliefs and practices that influence place of delivery for these pastoralist women.MethodsQualitative data were collected in five group ranches in Laikipia County and three group ranches in Samburu County. Fifteen in-depth interviews were conducted: seven with SBAs and eight with key informants. Nineteen focus group discussions (FGDs) were conducted: four with TBAs; three with community health workers (CHWs); ten with women who had delivered in the past two years; and two with husbands of women who had delivered in the past two years. Topics discussed included reasons for homebirths, access and referrals to health facilities, and strengths and challenges of TBAs and SBAs. The data were translated, transcribed and inductively and deductively thematically analysed both manually and using NVivo.ResultsSocio-demographic characteristics and cultural practices and beliefs influence pastoralist women’s place of delivery in Laikipia and Samburu counties, Kenya. Pastoralist women continue to deliver at home due to a range of factors including: distance, poor roads, and the difficulty of obtaining and paying for transport; the perception that the treatment and care offered at health facilities is disrespectful and unfriendly; lack of education and awareness regarding the risks of delivering at home; and local cultural values related to women and birthing.ConclusionsUnderstanding factors influencing the location of delivery helps to explain why many pastoralist women continue to deliver at home despite health services becoming more accessible. This information can be used to inform policy and program development aimed at increasing the proportion of facility-based deliveries in challenging settings.
Highlights
Kenya’s high maternal mortality ratio can be partly explained by the low proportion of women delivering in health facilities attended by skilled birth attendants (SBAs)
In 2013, the World Health Organization estimated that 289,000 women died during or following pregnancy and delivery [2], and more than half of these deaths occurred in sub-Saharan Africa
Many women in sub-Saharan Africa do not receive skilled health care during pregnancy and delivery, with a large proportion delivering at home assisted by traditional birth attendants (TBAs)
Summary
Kenya’s high maternal mortality ratio can be partly explained by the low proportion of women delivering in health facilities attended by skilled birth attendants (SBAs). Many women continue to give birth at home attended by family members or traditional birth attendants (TBAs). In 2013, the World Health Organization estimated that 289,000 women died during or following pregnancy and delivery [2], and more than half of these deaths occurred in sub-Saharan Africa. Many women in sub-Saharan Africa do not receive skilled health care during pregnancy and delivery, with a large proportion delivering at home assisted by traditional birth attendants (TBAs). A range of factors prevent women in sub-Saharan Africa from obtaining quality health care from the formal sector including living a long distance from health facilities, poor roads, lack of transport, poverty, cultural practices, lack of information, and poor quality health services [7,8,9,10,11,12,13]
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