Free Maternity Services Research Articles

The impact of Ghana’s national health insurance exemption policies on healthcare-seeking behaviour

Countries all over the world are seeking to enhance the general well-being of their populations by instituting a prepayment health system in which people can access healthcare at any time without financial risks. In Ghana, the National Health Insurance Scheme (NHIS) seeks to achieve this objective while leaving no one behind. To accelerate the country’s UHC agenda, the scheme was designed to also provide premium exemptions to the poor and vulnerable. While the exemption policy removes financial barriers to both subscription and healthcare, its impact on health-seeking is unknown. This study, therefore, sought to evaluate the impact of the premium exemption policies on healthcare-seeking behaviours. Data from the most recent round of the Ghana Living Standards Survey (GLSS 7) was used. A total sample of 8297 individuals were included in the analysis comprising 5686 rural and 2611 urban dwellers. We used the Lewbel instrumental variable technique to correct potential endogeneity problems. We found that NHIS exemption policies improved both general and formal healthcare-seeking. For general healthcare-seeking, the impact was driven by individuals exempted through under 18 and aged category. However, focusing on formal care, both exemption through under 18 or aged category as well as through indigents or Free Maternal Services category both improved healthcare-seeking. The magnitude of the impact was also greater for categories that were fully exempted and did not require any form of payment to subscribe. The findings call for a policy review to differentially target individuals living in areas with different economic and health system realities.

Can "the expanded free maternity services" enable Kenya to achieve universal health coverage by 2030: qualitative study on experiences of mothers and healthcare providers.

Universal health coverage is a global agenda within the sustainable development goals. While nations are attempting to pursue this agenda, the pathways to its realization vary across countries in relation to service, quality, financial accessibility, and equity. Kenya is no exception and has embarked on an initiative, including universal coverage of maternal health services to mitigate maternal morbidity and mortality rates. The implementation of expanded free maternity services, known as the Linda Mama (Taking Care of the Mother) targets pregnant women, newborns, and infants by providing cost-free maternal healthcare services. However, the efficacy of the Linda Mama (LM) initiative remains uncertain. This article therefore explores whether LM could enable Kenya to achieve UHC. This descriptive qualitative study employs in-depth interviews, focus group discussions, informal conversations, and participant observation conducted in Kilifi County, Kenya, with mothers and healthcare providers. The findings suggest that Linda Mama has resulted in increased rates of skilled care births, improved maternal healthcare outcomes, and the introduction of comprehensive maternal and child health training for healthcare professionals, thereby enhancing quality of care. Nonetheless, challenges persist, including discrepancies and shortages in human resources, supplies, and infrastructure and the politicization of healthcare both locally and globally. Despite these challenges, the expanding reach of Linda Mama offers promise for better maternal health. Finally, continuous sensitization efforts are essential to foster trust in Linda Mama and facilitate progress toward universal health coverage in Kenya.

Equity of access to free maternal and child health services among reproductive-age women in Delta State, Nigeria.

The study aimed to assess the equity of access to free maternal and child health services among reproductive-age women in Delta State, Nigeria. the study adopted a descriptive cross-sectional survey design. The population for the study were 368 women of reproductive age (15-49 years) who had given birth between April 2015 and December 2015 in two randomly selected senatorial districts of Delta State. Data were collected using a pre-tested interviewer-administered questionnaire. 368 women were recruited for the study, consisting of 73.3% (N =270) from the urban setting and 26.7% (N=98) from the rural setting. 54.1% (N=199) had completed secondary school, while 28.8% (N=106) had completed tertiary education. Most respondents were aged 21 to 30 years 217(59.0%). 20% of respondents belonged to the poorest, poor and least poor socioeconomic status (SES) groups and 19.8% to average poor and rich SES groups. The results showed equity between different SES (0.014) and educational (0.027) backgrounds, as indicated in concentration curves. However, the concentration index between the geographical areas (-0.0200) indicates inequity in access in favour of urban dwellers. Free maternal and child health services (FMCHS) were equitable across the different SES groups and educational levels. However, there was inequity in access due to distance to the hospitals among the women of childbearing age in the communities. This study is relevant to all healthcare professionals, especially those in public health, because it will encourage them to exercise their energy towards home care to reduce maternal and child mortality. None declared.

Correlates of adverse outcomes of adolescent pregnancy in Sidama region, Ethiopia. An unmatched case-control study

IntroductionAdolescent pregnancy has received little attention, despite being it is the leading cause of maternal mortality and morbidity in low-income countries, including Ethiopia. Sidama regional state is one of the regions in Ethiopia that has high rates of adolescent pregnancy. This study aimed to identify factors related to adverse outcomes of adolescent pregnancy, in the Sidama region, Ethiopia. MethodsA hospital-based unmatched case-control study was conducted among 120 cases and 240 controls of pregnant adolescents. Structured interviews and patient record reviews were used to examine the potential correlates and adverse outcomes of adolescent pregnancy. Using binary logistic analysis, adjusted odds ratio (AOR) with 95% confidence intervals, were computed to identify factors related to adverse outcomes of adolescent pregnancies. ResultsA monthly income below the poverty level (AOR: 3.40; 95% CI, 1.21–9.58), lack of antenatal care follow-up (AOR: 4.22; 95% CI, 1.97–9.04), experiencing gender-based violence (AOR: 2.03; 95% CI, 1.16–3.57), and referral to a specialized health facility (AOR: 2.79; 95% CI,1.39, 5.62) were associated with higher odds of adverse pregnancy outcomes. ConclusionSeveral socio-economic and health care system-related determinants are associated with adverse outcomes of adolescent pregnancy. Therefore, it is crucial to improve free and accessible maternal health care services for adolescents, focusing on education, challenging social norms that condone gender-based violence as well as enhancing the referral system to lessen the burden of adverse outcomes of adolescent pregnancy.

Hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia

BackgroundSince 2005, the healthcare system in Ethiopia has implemented policies to promote the provision of free maternal healthcare services. The primary goal of these policies is to enhance the accessibility of maternity care for women from various socioeconomic backgrounds. Additionally, the aim is to increase the utilization of maternity services, such as institutional deliveries, by removing financial obstacles that pregnant women may face. Even though maternity services are free of charge. The hidden cost has unquestionably been a key obstacle in seeking and utilizing health care services. Significant payments due to delivery services could create a heavy economic burden on households.ObjectivesTo determine the hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia 2023.MethodsA facility-based cross-sectional study was conducted on 411 postpartum women in Gamo Zone Public Health Hospitals from December 1, 2022, to January 30, 2023. The systematic sampling technique was applied to reach study units. Data was collected using the Kobo Toolbox Data Collection Tool and exported to SPSS statistical software version 27 for analysis. Simple linear regression and multiple linear regression were done to see the association of variables. The significance level was declared at a P-value < 0.05 in the final model.ResultThe median hidden cost of hospital-based delivery was 1142 Ethiopian birr (ETB), with a range (Q) of 2262 (504–2766) ETB. Monthly income of the family (β = 0.019), obstetrics complications (β = 0.033), distance from the health facility (β = 0.003), and mode of delivery (β = 0.072), were positively associated with the hidden cost of hospital-based delivery. While, rural residence (β = −0.041) was negatively associated with the outcome variable.ConclusionThis study showed the hidden cost of hospital based delivery was relatively high. Residence, monthly income of the family, obstetric complications, mode of delivery, and distance from the health facility were statistically significant. It is important to take these factors into account when designing health intervention programs and hospitals should prioritize the availability of essential drugs and medical supplies within their facilities to address direct medical costs in hospitals.

Validating the implementation of an indicator reporting policies and laws on free public maternal health-related services in the era of universal health coverage: A multi-country cross-sectional study.

The concept of universal health coverage (UHC) encompasses both access to essential health services and freedom from financial harm. The World Health Organization's Maternal Newborn Child and Adolescent Health (MNCAH) Policy Survey collects data on policies that have the potential to reduce maternal morbidity and mortality. The indicator, "Are the following health services provided free of charge at point-of-use in the public sector for women of reproductive age?", captures the free provision of 13 key categories of maternal health-related services, to measure the success of UHC implementation with respect to maternal health. However, it is unknown whether it provides a valid measure of the provision of free care. Therefore, this study compared free maternal healthcare laws and policies against actual practice in three countries. We conducted a cross-sectional study in four districts/provinces in Argentina, Ghana, and India. We performed desk reviews to identify free care laws and policies at the country level and compared those with reports at the global level. We conducted exit interviews with women aged 15-49 years who used a component service or their accompanying persons, as well as with facility chief financial officers or billing administrators, to determine if women had out-of-pocket expenditures associated with accessing services. For designated free services, prevalence of expenditures at the service level for women and reports by financial officers of women ever having expenditures associated with services designated as free were computed. These three sources of data (desk review, surveys of women and administrators) were triangulated, and chi-square analysis was conducted to determine if charges were levied differentially by standard equity stratifiers. Designation of services as free matched what was reported in the MNCAH Policy Survey for Argentina and Ghana. In India, insecticide-treated bed nets and testing and treatment for syphilis were only designated as free for selected populations, differing from the WHO MNCAH Policy Survey. Among 1046, 923, and 1102 women and accompanying persons who were interviewed in Argentina, Ghana, and India, respectively, the highest prevalence of associated expenditures among women who received a component service in each setting was for cesarean section in Argentina (26%, 24/92); family planning in Ghana (78.4%, 69/88); and postnatal maternal care in India (94.4%, 85/90). The highest prevalence of women ever having out of pocket expenditures associated with accessing any free service reported by financial officers was 9.1% (2/22) in Argentina, 64.1% (93/145) in Ghana, and 29.7% (47/158) in India. Across the three countries, self-reports of out of pocket expenditures were significantly associated with district/province and educational status of women. Additionally, wealth quintile in Argentina and age in India were significantly associated with women reporting out of pocket expenditures. Free care laws were largely accurately reported in the global MNCAH policy database. Notably, we found that women absorbed both direct and indirect costs and made both formal and informal payments for services designated as free. Therefore, the policy indicator does not provide a valid reflection of UHC in the three settings.

A multilevel analysis of social determinants of skilled birth attendant utilisation among married and cohabiting women of Madagascar.

Maternal mortality ratio (MMR) in Madagascar is 392 deaths per 100000 live births, and this is a major public health concern. One of the strategies for reducing MMR and achieving target 3.1 of the Sustainable Development Goals (i.e. reducing the global MMR below 70 per 100000 live births) is the utilisation of skilled birth attendants (SBAs). This analysis examined the prevalence and social determinants of SBA utilisation among married and cohabiting women of Madagascar. Data from the 2021 Madagascar Demographic and Health Surveys was analysed on a weighted sample of 6997 married and cohabiting women. A multilevel regression was carried out to determine the social determinants of utilising SBAs. The results are presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and a p-value <0.05 to determine the significant associations. The prevalence of SBAs among married and cohabiting women of Madagascar was 64.4% (95% CI 0.62 to 0.68). In model 3 of the multilevel regression, women 35-39y of age (adjusted OR [aOR] 1.86 [95% CI 1.30 to 2.60]), women with secondary/higher education (aOR 1.67 [95% CI 1.32 to 2.10]), women whose partners had secondary/higher education (aOR 1.58 [95% CI 1.25 to 1.99]), cohabiting women (aOR 1.33 [95% CI 1.07 to 1.65]), women who had four or more antenatal care visits (aOR 2.05 [95% CI 1.79 to 2.35]), female household head (aOR 1.44 [95% CI 1.06 to 1.95]), Muslims (aOR 1.58 [95% CI 0.71 to 3.53]), those of the richest wealth index (aOR 4.32 [95% CI 2.93 to 6.36]) and women who lived in communities with high literacy levels (aOR 2.17 [95% CI 1.57 to 3.00]) had higher odds of utilisation of SBA. This current analysis revealed low SBA utilisation among married and cohabiting women in Madagascar. The analysis points to the fact that understaffing and inaccessibility of health facilities remain major contributors to the low utilisation of SBAs. The findings call on the government and stakeholders in Madagascar to consider implementing programs that will empower women and focus on disadvantaged groups. These programs could include providing free maternal healthcare services to all pregnant women and intensifying health education programs that target women and their partners with no formal education.

Influence of Stakeholder Dynamics on Performance of Free Maternal Healthcare Project in Kenya, a Case of Homabay County

Purpose: The study examined the influence of sponsor, client, project team and regulatory dynamics, on project performance of free maternity in Homabay County, Kenya.The research focused on factors other than healthcare costs to ensure adequate infrastructure and health personnel in order to offer quality care for the growing number of clients. Besides it added to the existing body of knowledge pertaining to the delivery of free maternity services thereby reducing and eliminating maternal and perinatal deaths. It was conducted in eight sub-county hospitals in the county.&#x0D; Methodology: A total of 167 respondents were selected to participate in the study. The data were entered and analyzed by SPSS version 16. The coefficient of determination showed that sponsor dynamics had a major contribution to the project performance.&#x0D; Findings: There was a significant positive relationship between sponsor dynamics and project performance of free maternal healthcare in Homabay County, Kenya.&#x0D; Unique contribution to theory, practice and policy: The study therefore recommended that Donors and other implementing agencies ought to make their procedures flexible in order to accommodate input from other project stakeholders.

The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study.

Pregnant women face high costs for health-care services despite being advertised as free. These costs include non-medical expenses, lost productivity, difficulties caring for family members, and long-term financial impact from complications. Limited research has been done on the cost burden of maternal services and complications, despite numerous studies on maternal health service provision. This is notable considering the government's claim of providing free maternal health-care services. A cross-sectional study was conducted in July (1-30) 2022 among 425 randomly selected mothers in Harari and Dire Dawa City, Eastern Ethiopia. Data were collected through structured questionnaires and medical record reviews. The collected data was entered into Epi-Data version 3.02 and analyzed using STATA version 14.0 after data cleaning. Descriptive statistics and linear regression analysis were used to examine the data, ensuring assumptions of linearity, independence, homoscedasticity, and normality were met. The correlation coefficient was used to assess the strength of the association. The median cost of maternal complications was around 4250 ETB (81.3 USD; IQR = 2900-5833.3), factors that predicted cost were monthly family income of ≥3001 birr (β=1.13; 95% CI: 1.00, 1.26), distance from hospital (β=0.73; 95% CI = 0.64-0.83), being admitted for less than 4 days (β=0.60; 95% CI = 0.53-0.69), accompanied by relatives besides their husbands (β=1.93; 95% CI = 1.52-2.46), caesarian sections delivery (β=1.17; 95% CI = 1.04-1.31), and giving birth to a normal baby (β=0.86; 95% CI = 0.77-0.97). Maternal complications incur significant costs, with factors such as family income, travel time, hospital stay, caregiver presence, mode of delivery, and neonatal outcome predicting these costs. The Ethiopian health system should address the additional expenses faced by mothers with complications and their caregivers.

Local perspectives on policy implementation of free maternity health services in Kenya: Implications for universal health coverage.

Kenya introduced free maternity services (FMS) in 2013 to enable all pregnant women to give birth for free in all government public health facilities. Currently, Kenya is rolling out universal health coverage (UHC), which has been acknowledged as a priority goal for every health system and part of the 'Big Four Agenda' for sustainable national development in Kenya. FMS is one of the core services in Kenya, but since its launch, it is not clear whether the decentralized approach chosen to implement FMS is leading to UHC. This nine-month ethnographic study in Kilifi County, Kenya, was conducted between March-July 2016 and February-July 2017. A narrative approach to analysis was applied. In this article, we interrogate local perceptions of participation during the crafting and implementation of FMS. Findings show that FMS was detached from local realities, and this was a major inadequacy of the top to bottom approach. FMS did not consider local power relations and bargaining power which are requisites during policy formulation and implementation. The participants expressed desire for more localized control over resources from the national government. The findings suggest that as UHC is rolled out in Kenya, consultation of local stakeholders at the grassroots by the state departments would likely improve maternal healthcare outcomes. Such consultations must take into consideration differences in bargaining power and local power relations. Borrowing from the basic tenets of the recent anthropological theorization of constitutionality, this article proposes a bottom to top approach that leverages and integrates local views during policy-making process to create trust, a sense of ownership and accountability.

Implementing a Community-Based Participatory Approach to Promote Health Facility Delivery among Women of Reproductive Age in Kanamai Area, Kilifi County

Maternal utilization has been low over the years in Kenya. Approaches to establish safe motherhood through promotion of health facility have been equally fronted. This study applied certain aspects of community education approach encompassing group discussion and community dialogue to provide a clear insight of how the approach is a vital tool. Community based cross sectional study was conducted in Kanamai sub-location, Kilifi County to recruit 232 women selected by simple random sampling technique. The data were collected using pre-tested semi-structured questionnaires and the collected data was coded, entered, cleaned, and analysed using R for Windows (version 4.0.3). Sixty-nine percent (69%) of women advocated for the delivery at the designated health facilities. Independent factors that were found to influence health facility based delivery in this study were being employed (OR = 12.42, 95% CI: 6.25 - 24.70, p&lt;0.0001), having given birth to 3-4 children, (OR = 2.56, 95% CI: 6.25 - 24.70, p=0.0062) and rating of both group discussion (OR = 0.15, 95% CI: 0.03 -0.66, p=0.0041) and community dialogue (OR = 0.21, 95% CI: 0.08 - 0.59, p=0.0013) to be low. Leading by the example set by the government of offering free maternal services, engaging the key stakeholders through approaches such as group discussion and community dialogue could go a long way in increasing delivery in the health facilities thus tremendously lowering mortality rate for both the baby and the mother which could otherwise occur when the mother doesn’t get services of a specialized personnel. Keywords: Advocacy, Delivery, Community Education Group Discussion, Community Dialogue.

Exploring the Factors Influencing Home Delivery: A Cross Sectional Study among Rural Residents in Tamale Metropolis

Introduction: Maternal and child mortality continues as a disturbing public health problem facing Ghana and other low and middle-income countries. As such there are advocacy for skilled birth delivery. Despite the advocacy, in most rural communities, unskilled delivery still persists. It is against this background that this study aims to explore the factors influencing home delivery among women in rural areas of Tamale Metropolis.&#x0D; Methods: The study employed the descriptive cross-sectional design with the mixed method approach. The study recruited 200 women within reproductive age of 18-49 who had delivered at least once in the selected rural communities in the Tamale Metropolis. Questionnaire and interview guide were used to collect data for this study. The data was analyzed using SPSS version 26 and manual thematic content analysis for quantitative and qualitative data respectively.&#x0D; Results: The prevalence of home delivery was reported as (36.5%) among the respondents. More than quarter (35.5%) of the respondents rate their satisfaction of home delivery as good whereas more than half of the respondents rated TBAs’ attitude as good. Three (3) qualitative respondents indicated that most women chose to deliver at home in neglect of hospital because of better satisfaction gained from delivering at home. The qualitative data showed that the factors identified to influence home delivery were as followed: negative attitude of health workers, lack of trust in health workers competence, unnecessary expenses from hospitals, distance, and poor quality of services. Nearly 90.0% of the respondents were enrolled on the NHIS with a proof of active NHIS card. Majority of the respondents were aware of the free maternal health services and all respondents agreed that they had a CHPs compound in their communities, however, only 36.5% responded in the affirmative that these CHPs compound are resourced adequately.&#x0D; Conclusion: The study showed a substantive percentage of the respondents to be practicing home delivery with the support of unskilled birth attendants. Poor attitudes from health workers, better previous experience in delivering at home, unreliable means of transport to the hospital and additional informal delivery expenses were some of the factors found to be significant determinants of home delivery. It is recommended for the government and other stakeholders to provide rural ambulance services to aid in the transport of pregnant women in labor to the nearest health facility.

Impact of free maternity services on outcomes related to hypertensive disorders of pregnancy at Moi Teaching and Referral Hospital in Kenya: a retrospective analysis

BackgroundPreeclampsia is a major contributor to maternal and neonatal mortality worldwide. Ninety-nine percent of these deaths occur in resource limited settings. One of the greatest barriers to women seeking medical attention remains the cost of care. Kenya implemented a nation-wide policy change in 2013, offering free inpatient maternity services to all women to address this concern. Here, we explore the impact of this policy change on maternal and neonatal outcomes specific to the hypertensive disorders of pregnancy.MethodsWe conducted a retrospective cross-sectional chart review of patients discharged or deceased with a diagnosis of gestational hypertension, preeclampsia, eclampsia or HELLP syndrome at a tertiary referral center in western Kenya one year before (June 1, 2012-May 31, 2013) and one year after (June 1, 2013-May 31, 2014) free maternity services were introduced at public facilities across the country. Demographic information, obstetric history, medical history, details of the current pregnancy, diagnosis on admission and at discharge, antepartum treatment, maternal outcomes, and neonatal outcomes were collected and comparisons were made between the time points.ResultsThere were more in hospital births after policy change was introduced. The proportion of women diagnosed with a hypertensive disorder of pregnancy was higher in the year before free maternity care although there was a statistically significant increase in the proportion of women diagnosed with gestational hypertension after policy change. Among those diagnosed with hypertensive disorders, there was no difference in the proportion who developed obstetric or medical complications. Of concern, there was a statistically significant increase in the proportion of women dying as a result of their condition. There was a statistically significant increase in the use of magnesium sulfate for seizure prophylaxis. There was no overall difference in the use of anti-hypertensives between groups and no overall difference in the proportion of women who received dexamethasone for fetal lung maturity.ConclusionsFree maternity services, however necessary, are insufficient to improve maternal and neonatal outcomes related to the hypertensive disorders of pregnancy at a tertiary referral center in western Kenya. Multiple complementary strategies acting in unison are urgently needed.

Out-of-pocket payments during childbirth in Kenya under the free maternity services: Perspectives of mothers, healthcare workers and county officials

Background: This study seeks to determine the extent of women's out-of-pocket (OOP) payments for delivery under the free maternity policy (FMP). Methods: We conducted a convergent parallel mixed-methods study using quantitative and qualitative data collection. The study was set in three facilities (levels 3, 4, and 5) in Kiambu County, Kenya. The study involved exit interview (EI) surveys with mothers (n = 553) who utilised FMP delivery services and focus group discussions (FGDs) with mothers who returned for postnatal visits (6, 10, and 14 weeks). There were 21 in-depth interviews (IDIs) with county officials and healthcare workers (HCWs). Quantitative data were analysed using descriptive statistics, while qualitative data were audio-recorded, transcribed and analysed using thematic analysis. Results: Despite the FMP being free on paper, mothers incurred OOP payments in practice. The overall mean OOP payments incurred by mothers who underwent normal delivery was 9.50 USD (SD 8.20 USD), and caesarean section (CS) was 10.88 USD (SD 15.16 USD). The main cost drivers were transport, lack of adequate supply and medications, lack of policy clarity by health workers, failure to notify the NHIF office of available clients, and ultrasound scan services. While the OOP payments were not deemed catastrophic, some women perceived it as a barrier to care as they ended up using savings or selling their assets to meet the costs. There were no patient characteristics associated with OOP payments. Conclusions: OOP payments during childbirth in Kenya place a considerable economic burden on mothers and their households. There is need to promote awareness of the policy and provide a sustainable form of transport, especially during emergencies, through collaboration with partners. Prioritising the supply of required medication used in maternal services in the universal health care benefits package to which Kenyan citizens are entitled, or sustainably financing the FMP is crucial.

Anti-Politics and Free Maternal Health Services in Kilifi County, Kenya

ABSTRACT Maternal healthcare is a global agenda. Kenya introduced free maternity services (FMS) in 2013 to allow women to give birth for free in all government public health facilities. The introduction of FMS was timely due to the high maternal mortality rate in Kenya. FMS was also introduced to fulfil the Jubilee Party government’s elections campaign promises. It is, however, not known how primary beneficiaries and health providers perceived the FMS roll-out following the presidential directive in 2013. This article aims to explore the roles of political contestations in FMS as a social protection scheme in Kenya. In this qualitative ethnographic study in Kilifi County, we interviewed the mothers who utilised FMS and the health workers who implemented the policy. The data gathered was analysed contextually and thematically. The prevailing narrative from the health services professionals and the mothers who participated in our study is that FMS is ‘the president’s thing’ and has a clear political orientation; it is seen as deceiving the public in two ways: first by shrouding political interests, and second by adding to the burden of women, as delivery was not free – all the other services and medication before and after birth came at a cost. Health workers feel helpless and frustrated and, in most cases, they have to cope with meagre resources to ensure safe births. In some cases, quality of care is compromised due to supply-side constraints. This article shows how social protection has been used to gain political mileage and has not considered the local needs of the maternal healthcare system.

The healthcare system and client failures contributing to maternal mortality in rural Kenya

BackgroundThe global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government’s provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya.MethodsAn explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains.ResultsIdentified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients’ ANC non-adherence.ConclusionIn conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.

Demographic Factors Associated With Utilization of Free Maternity Services Among Women of Reproductive Age Receiving Care at Saboti Sub-County Hospital, Kenya

Demographic Factors Associated With Utilization of Free Maternity Services Among Women of Reproductive Age Receiving Care at Saboti Sub-County Hospital, Kenya

Satisfaction on Antenatal Care among Pregnant Women in a Primary Health Care Centre

Introduction: Antenatal care service (ANC) is most important to reduce complication during pregnancy. However, satisfaction is needed during ANCs visits for the continuation of the health services and improvement in the quality of the health care in the Primary Health Care Centre (PHCC).The objective of this study was to assess pregnant women in PHCC.&#x0D; Methods: A cross sectional study was done in PHCC of Nawalparasi through face to face interview technique with structured interview schedule to collect the data.Total of 101 pregnant mothers were selected for the study. Consecutive sampling technique was used for sampling.The collected data was entered in Epidata and analysed in SPSS version 16.&#x0D; Results: Findings of the study indicated most 99 percent of the respondents were satisfied with antenatal care among the age group of 15- 49 years. Most 99 percent of the respondents were satisfied with service expectation and only 87.1 percent were satisfied with availability of health services.&#x0D; Conclusion: The study concluded that satisfaction among pregnant women on ANC is very high in PHCC. Still there is need for the conduction of different maternal health programs to enhance maternal and child health as well as provide free maternal health services to remove financial barriers.

Determinants of Health Facilities Influencing Utilization of Free Maternity Services Among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County

Free maternity services is the offering of medical and obstetric care to pregnant women without any financial cost. Complications related to pregnancy were a major reproductive health problem that lead to disability and increased maternal deaths. Free maternity was introduced in Kenya in 2013 with a focus of achieving 100% utilization of the service and reducing high mortality rate. Homa-Bay County had a low percentage of 54% deliveries taking place in health facilities within the county. The main objective of this study was to establish Determinants of Health facilities Influencing Utilization of Free Maternity Services among Women of Reproductive Age 15-49 Years Attending Health Facilities in Homa-Bay County. Descriptive cross-sectional study design was applied to establish the main objective of this study. A probability and non-probability sampling techniques was used to select 420 respondents. The study utilized quantitative and qualitative methods of data collection. Data analysis was conducted with aid of Statistical Package for Social Scientists (SPSS) version 23. Analysis methods used were; factor analysis and regression analyses methods for quantitative data to determine the relationship and associations among the variables. Qualitative data was analyzed through content analysis by conducting thematic analysis. A total of 396 that was 94% response rate established 54% (213/396) mothers were interviewed and were aged between 20 years and 29years. Results showed that; age of the mothers was insignificant in utilization of free maternity services. Further analysis using logistics regression revealed that the respondents who agreed with the need for a well-equipped health facility with good sanitation system were 63% (OR 0.37, p = 0.03) more likely to reuse FMS. Distance was insignificant in utilization as long as the facility was well-equipped and adequately staffed as 57% (228/396).This study concluded that there was significant association between staff respect, and honesty of the staff with utilization of free maternity service. This study recommended that the County Government of Homa-Bay should increase awareness to women of reproductive age at the community level about FMS through Community health promotion officers in order to improve FMS uptake in Homa-Bay County.

Community perception of barriers and facilitators to institutional delivery care-seeking behavior in Northwest Ethiopia: a qualitative study

BackgroundInstitutional delivery care-seeking behavior is considered a crucial step in preventing maternal and child death. However, the barriers and facilitators related to institutional delivery care-seeking behavior in the study area were not studied very in-depth. Hence, the current study aimed to explore barriers and enablers of institutional delivery care-seeking behavior in Northwest Ethiopia.MethodsA descriptive phenomenological qualitative inquiry was used. The data was collected by using a piloted interview guide. We collected data using in-depth interviews among women and men; and key informant interviews from the Female health development army and health extension workers in November and December 2019. Framework analysis was utilized for the analysis of the data.ResultsThis study found out the potential factors which hinder and facilitate institutional delivery. The barriers to institutional delivery included the belief that pregnancy and childbirth are normal and business of women’s, women’s preference of home delivery with traditional attendants, family influence, fear of bad behavior of health care workers, and lack of resources. The facilitators were free maternal services (ambulance services and maternity services), having the experience of safe childbirth at health facilities, and women’s health development army linkage with health extension workers.ConclusionThis study provides evidence that low-risk perception of home delivery, socio-cultural influences, service provision modalities, and financial factors were the determinants of institutional delivery service use. Therefore, a stage-matched intervention shall be designed to improve the uptake of institutional delivery service use.