Narratives of Women Using a 24-Hour Ride-Hailing Transport System to Increase Access and Utilization of Maternal and Newborn Health Services in Rural Western Kenya: A Qualitative Study.

Maricianah Onono,Mildred Anyango Owenga,Titus Serem,Ouma Congo,Pauline Wekesa,Lawrence Wandei Waguma,Gladys Ombonya Odhiambo

doi:10.4269/ajtmh.19-0132

Maricianah Onono, Mildred Anyango Owenga + Show 5 more

Open Access

https://doi.org/10.4269/ajtmh.19-0132

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Abstract

.Between 1990 and 2015, Kenya had a 0.9% annual reduction in maternal mortality, one of the lowest reductions globally. This slow decline was linked to the relatively low utilization of delivery services. We designed a mobile phone–enhanced 24-hour transport navigation system coupled with personalized and interactive gestation-based text messages (MAccess) to address maternal child health service utilization. The primary purpose of this analysis is to explore the ways in which pregnant and postnatal women made decisions regarding care-seeking for pregnancy and childbirth services, the processes of getting care from home to the hospital as well their perceptions on how the MAccess intervention affected their pregnancy and childbirth care-seeking and utilization experience. We conducted semistructured, individual interviews with 18 postpartum women. Participants were purposively sampled. Interviews were audiotaped, transcribed, and analyzed using thematic analysis. For participants in this study, all three delays interacted in a complex manner to affect women’s utilization of pregnancy and childbirth services. Even though women were aware of the benefits of skilled birth attendance, other health system factors such as opening hours, or health workers’ attitudes still deterred women from delivering in health facilities. The MAccess innovation was highly acceptable to women throughout pregnancy and childbirth and helped them navigate the complex and layered individual, infrastructural, and health system factors that put them at risk of adverse maternal and newborn outcomes. These findings emphasize that an integrated approach, which addresses all delays simultaneously, is important for reducing perinatal morbidity and mortality.

Highlights

303,000 women die from pregnancy-related complications, and almost all of them occur in developing countries, in Africa and Asia.[1,2] Approximately 60% of the maternal deaths are due to sepsis, hemorrhage, hypertensive disorders, obstructed labor, and unsafe abortion.[3,4] In addition, for each woman who dies as the direct or indirect result of pregnancy, a significantly higher number experience a lifethreatening complication that will require attention of skilled obstetric caregivers to prevent morbidity and mortality.[5]
10% of mothers suffer a maternal complication during pregnancy or in the intra-partum period, and up to 40% may have morbidities post-birth that are attributable to the pregnancy or birth.[4]
Most of these complications are treatable and preventable during antenatal care (ANC) and if births are overseen by skilled birth attendants.[3]

Summary

Introduction

303,000 women die from pregnancy-related complications, and almost all of them occur in developing countries, in Africa and Asia.[1,2] Approximately 60% of the maternal deaths are due to sepsis, hemorrhage, hypertensive disorders, obstructed labor, and unsafe abortion.[3,4] In addition, for each woman who dies as the direct or indirect result of pregnancy, a significantly higher number experience a lifethreatening complication that will require attention of skilled obstetric caregivers to prevent morbidity and mortality.[5]. The primary purpose of the analysis was to explore the ways in which pregnant and postnatal women made decisions regarding care-seeking for pregnancy and childbirth services, the processes of getting care from home to the hospital as well as their perceptions on how the MAccess

Results

Conclusion