Healthcare System Factors Influencing Access and Utilization of Skilled Birth Services among Pastoralist Women in Loima Sub- County, Turkana County, Kenya

Abstract

Objectives: To determine access to skilled birth services among women of reproductive age, to asses health care interventions influencing the utilization of skilled birth services and to explore barriers influencing the utilization of skilled birth services. Methods: A mixed-methods study design was employed, conducted from March to June 2024. For the quantitative component, a sample of 384 women aged 15–49 years who had given birth within the previous two years at the time of study was selected using a two-stage cluster sampling method. First, villages were selected from each of the four wards in the sub-county using probability proportional to population size. In the second stage, households were systematically sampled with an interval of 5 households. Qualitative data were collected through 20 in-depth interviews (upon reaching data saturation) with key informants, including community health volunteers (CHVs), traditional birth attendants, and healthcare providers. Quantitative data were analyzed using logistic regression to determine factors associated with skilled birth utilization, while qualitative data were analyzed thematically to identify barriers to skilled birth utilization. Results: The bivariate analysis shows significant association at P<0.05 between marital status P<0.03, household size P< 0.01, distance to health facilities P< 0.04 availability of supplies P<0.02, reception by service providers P<0.05 and birthing experiences P< 0.02. These results suggest that women who are married, have smaller households, live closer to health facilities, and receive better care and resources are more likely to utilize skilled delivery services. The multivariate logistic analysis identifies the independent predictors of skilled delivery utilization. Factors such as being single (OR=3.75, CI=0.58-5.97), having more than five children (OR=0.60, CI=0.45-0.80), and living more than 5 km from a health facility (OR=1.96 CI=0.53-2.92) were associated with lower odds of utilizing skilled delivery services. Economic barriers included low household income, with most women engaging in small-scale farming and their spouses working as casual laborers or herders. Facility-based interventions such as health talks by nurses/midwives and community health education increased utilization of skilled birth services. Conclusion: Healthcare system barriers substantially constrain access and utilization of skilled birth services in pastoral settings. Strengthening rural health systems through improved infrastructure, staffing, supply chains, and referral systems is essential for improving maternal health outcomes.