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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study

Authors: Linda Mason, Stephanie Dellicour, Feiko Ter Kuile, Peter Ouma, Penny Phillips-Howard, Florence Were, Kayla Laserson, Meghna Desai

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

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Abstract

Background

In western Kenya, maternal mortality is a major public health problem estimated at 730/100,000 live births, higher than the Kenyan national average of 488/100,000 women. Many women do not attend antenatal care (ANC) in the first trimester, half do not receive 4 ANC visits. A high proportion use traditional birth attendants (TBA) for delivery and 1 in five deliver unassisted. The present study was carried out to ascertain why women do not fully utilise health facility ANC and delivery services.

Methods

A qualitative study using 8 focus group discussions each consisting of 8–10 women, aged 15–49 years. Thematic analysis identified the main barriers and facilitators to health facility based ANC and delivery.

Results

Attending health facility for ANC was viewed positively. Three elements of care were important; testing for disease including HIV, checking the position of the foetus, and receiving injections and / or medications. Receiving a bed net and obtaining a registration card were also valuable. Four barriers to attending a health facility for ANC were evident; attitudes of clinic staff, long clinic waiting times, HIV testing and cost, although not all women felt the cost was prohibitive being worth it for the health of the child. Most women preferred to deliver in a health facility due to better management of complications. However cost was a barrier, and a reason to visit a TBA because of flexible payment. Other barriers were unpredictable labour and transport, staff attitudes and husbands’ preference.

Conclusions

Our findings suggest that women in western Kenya are amenable to ANC and would be willing and even prefer to deliver in a healthcare facility, if it were affordable and accessible to them. However for this to happen there needs to be investment in health promotion, and transport, as well as reducing or removing all fees associated with antenatal and delivery care. Yet creating demand for service will need to go alongside investment in antenatal services at organisational, staffing and facility level in order to meet both current and future increase in demand.
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Metadata
Title
Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study
Authors
Linda Mason
Stephanie Dellicour
Feiko Ter Kuile
Peter Ouma
Penny Phillips-Howard
Florence Were
Kayla Laserson
Meghna Desai
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0453-z

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