Being perceived as ‘a real woman’ or following one's own convictions: a qualitative study to understand individual, family, and community influences on the place of childbirth in Busia, Kenya (original) (raw)
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Culture and Birthing: Experiences from a Rural Community in Western Kenya
Sociology and Anthropology, 2018
Despite numerous campaigns to increase uptake of hospital delivery services in Kenya, skilled birth attendance is still low. The situation is particularly worse for marginalized rural communities, including the Marakwet of western Kenya. Marakwet County ranks far below the national health survey indicators, with only 28% of the women delivering in hospitals compared to the average national index, which is at 62% [1]. Different reasons are cited for the low health facility use by women during delivery. Drawing from a study on determinants of birthing sites conducted among the Marakwet of western Kenya, this paper discusses the socio-cultural factors that influence women's choice of the site of birthing. The study employed both qualitative and quantitative methods of data collection and analysis and it reports the qualitative findings. A total of 186 mothers, selected using multistage cluster sampling, were interviewed. Three focus group discussions with participants ranging from 8-12 were conducted, one with mothers below 20 years of age, another with mothers above 45 years of age and the third one with married men. A total of 29 participants participated in the FGDs. The FGDs participants were separately selected and were outside the 186 sampled informants. The study found that traditional birth attendants, rituals performed in the birthing process, and disposal of the placenta were the critical socio-cultural factors influencing the Marakwet women choice of birthing site. The paper concludes that understanding and addressing these factors is the key to any intervention programs designed to improve the reproductive health of women through the utilization of hospital as a birthing site.
BMC Pregnancy and Childbirth
Background The North Eastern region in Kenya experiences challenges in the utilization of maternal and newborn health services. In this region, culture and religion play a major role in influencing healthcare seeking behaviour of the community. This study was conducted to (i) understand key inherent barriers to health facility delivery in the Somali community of North Eastern Kenya and (ii) inform interventions on specific needs of this community. Methods The study was conducted among community members of Garissa sub-County as part of a baseline assessment before the implementation of an intervention package aimed at creating demand and increasing utilization of maternal and newborn services. Focus group discussions and key informant interviews were conducted with clan leaders, Imams, health managers, member of the county assembly, and service users (women and men) in three locations of Garissa sub-County. Data were analysed through content analysis, by coding recurrent themes and p...
Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study
BMC Pregnancy and Childbirth, 2015
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.
Health Policy and Planning, 2008
Through an analysis of focus group discussion data, we examine Kenyan traditional birth attendants' (TBAs) accounts of the persistence of homebirths and the key challenges they present. TBAs associated the continued demand for homebirths with the wide-ranging character and quality of their services. They did not consider their lack of formal training on matters of pregnancy and birthing to be a particular challenge to their work. Rather, they identified the non-cooperative and disrespectful attitudes of their counterparts in hospital settings as the most important issue. Further efforts are needed to make TBAs realize how much better their services could become if they adopted more modern ways of assisting in deliveries, unlearnt their belief in the superiority of their particular type of practice, and understood how their lack of formal training is a key issue.
International Journal of Africa Nursing Sciences, 2017
Background: Skilled birth attendance, a proven way of reducing maternal and perinatal mortality has remained low in low resource settings. Traditional Birth Attendants (TBAs) have continued to be culturally and socially accepted in many societies despite their limitation in handling childbirth complications. The study objective was to assess the perception of traditional birth attendants (TBAs) by the men and women of reproductive age in rural Migori. Methodology: This was a qualitative study carried out in four villages in Migori County, Nyanza region which involved married women of child bearing age and married men. Separate focus group discussions (FGDs) were done for men and women, where one FGD was conducted per group in each village. Content analysis was done after coding and categorizing data into thematic areas. Results: The findings indicated varied perceptions of men and women about the TBAs. Themen appreciated the services of TBAs mainly because of financial reasons while women enjoyed their friendly attitude and welfare services. The community was well aware of the risks of delivering with a TBA, however, they still opted for their services for reasons such as availability, accessibility and their friendly attitude. Conclusion: The men and women of reproductive had varied perceptions, both positive and negative about the traditional birth attendants. The TBAs still have a role to play in the community.
Reproductive Health
Background: Maternal health outcomes in resource-limited settings are typically influenced by supply-side factors affecting the provision of quality health services. The extent to which demand-side factors contribute to this influence is unclear. We aimed to explore how individual and community-wide factors influenced uptake and utilization of maternal health services among the Digo community residing in Kwale County of coastal Kenya. Methods: Between March and December 2015, we conducted 5 focus group discussions (FGDs) and 15 in-depth interviews (IDIs) with members of the Digo community predominant in Kwale county, Kenya. Respondents were sampled purposively and included female (pregnant and postpartum) as well as male adult community members. A thematic content analytic approach was used. Results: There were a total of 47 FGD respondents, including 15 (32%) females with a median (interquartile, IQR) age of 38 (27-55) years and 6 (3-8) children. Majority (40%) reported attaining secondary-level education. All IDI respondents were female with a median (IQR) age of 27 (24-35) years and 4 (2-5) children. Majority (80%) had attained primary-level education. We found that religious and socio-cultural norms as well as gender stereotypes were important influences on the uptake and utilization of maternal health services, including facility-based delivery and contraception. Key amongst this was the unspoken deference to the counsel of a prominent matriarchal figure in the decision-making process.
Deliver on Your Own: Disrespectful Maternity Care in rural Kenya
ABSTRACTBackgroundUnder the Free Maternity Policy (FMP), Kenya has witnessed an increase health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more work needs to be done.AimUsing data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project’s qualitative gender assessment, this paper examines and describes women’s experience of disrespectful care during pregnancy, labour and delivery. The goal is to promote improved understanding of actual care conditions in order to develop interventions that can lift the standard of care, increase maternity facility use, and improve health outcomes for both women and newborns.MethodologyWe conducted sixteen focus group discussions (FGDs) with female adolescents, women, men and community health...
85 Delivery choice in Kenya African Journal of Reproductive Health
2018
More than 95% of Kenyan women receive antenatal care (ANC) and only 62% access skilled delivery. To explore women's opinion on delivery location, 20 focus group discussions were conducted at an urban and rural setting in western Kenya. Participants included health care workers, traditional birth attendants (TBAs), and women who attended at least four ANC visits and delivered. Six in-depth interviews were also conducted with a combination of women who gave birth in a facility and at home. Discussions were digitally recorded and transcribed for analysis. Data was subjected to content analysis for deductive and inductive codes. Emergent themes were logically organized to address the study topic. Findings revealed that delivery services were sought from both skilled attendants and TBAs. TBAs remain popular despite lack of acknowledgement from mainstream health care. Choice of delivery is influenced by financial access, availability and quality of skilled delivery services, physical ...
Reproductive Health, 2021
Background Kenya continues to have a high maternal mortality rate that is showing slow progress in improving. Peri-urban settings in Kenya have been reported to exhibit higher rates of maternal death during labor and childbirth as compared to the general Kenyan population. Although research indicates that women in Kenya have increased access to facility-based birth in recent years, a small percentage still give birth outside of the health facility due to access challenges and poor maternal health service quality. Most studies assessing facility-based births have focused on the sociodemographic determinants of birthing location. Few studies have assessed women’s user experiences and perceptions of quality of care during childbirth. Understanding women’s experiences can provide different stakeholders with strategies to structure the provision of maternity care to be person-centered and to contribute to improvements in women’s satisfaction with health services and maternal health outco...