Determinants of birthing site among women in Endo ward, Marakwet east sub County, Kenya

Abstract

The decisions that women make when choosing a birthing site play a significant role in determining the maternal and neonatal health outcomes. According to World Health Organization, more than 90% of all maternal mortalities occur in the less developed countries where deliveries are often conducted by unskilled birth attendants. Kenya seems not to be on track to achieve the Millennium Development Goal No.5, which had set a target of reducing maternal mortalities by three quarters between 1990 and 2015, by increasing uptake of hospital delivery services. The percentage of women who deliver in hospitals in Marakwet district is a dismal 28% compared to the national average of 44%. Recognizing that the single most important factor to reducing maternal deaths is through hospital delivery, this study sought to find out what factors influence the choices of birthing site among women in Marakwet East Sub County. The objective of the study was to explain the socio-demographic, socio-cultural and healthcare system factors that influence the women’s choice of birthing site in Endo Ward, Marakwet East Sub County. The study was guided by two complementary models namely the Health Belief Model and Socio-Behavioural Theory by Andersen (1968). A descriptive survey design was used. The target population comprised mothers who had previously delivered. A total of 186 mothers were interviewed. Three focus group discussions were conducted with mothers below 20 years of age, mothers above 45 years of age and married men respectively. In-charges of two health facilities and two traditional birth attendants participated in key informant interviews to yield in-depth qualitative data on the determinants of birthing site. Multistage cluster sampling was used to select women who had delivered previously, and purposive sampling was used to select FGD participants and key informants. An interview schedule, key informant guide and FGD guide were used to collect socio- demographic, socio-cultural and healthcare systems factors, which influence the choice of birthing site. The study found that age, level of education, level of income and occupation were the major demographic factors affecting choice of birthing site. Socio-cultural factors identified include rituals performed in the birthing process, disposal of the placenta and rituals in the post partum period. Healthcare system factors affecting the choice of birthing site included distance, cost, quality of care in the facilities, and the gender of the healthcare providers. In conclusion, multiple factors, including socio-demographic, socio-cultural and healthcare system factors, play a role in determining the choice of birthing site in Endo Ward. The study recommends that social behavioural change communication should be utilized to address socio-cultural barriers to the utilization of hospital as birthing site.