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

Mason, Linda, Dellicour, Stephanie, terKuile, Feiko ORCID: https://orcid.org/0000-0003-3663-5617, Ouma, Peter, Phillips-Howard, Penelope ORCID: https://orcid.org/0000-0003-1018-116X, Were, Florence, Laserson, Kayla and Desai, Meghna (2015) 'Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study'. BMC Pregnancy and Childbirth, Vol 15, e26.

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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.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Administration and Organization > WA 550 Family planning WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12884-015-0453-z
Depositing User:	Helen Wong
Date Deposited:	18 Feb 2015 11:33
Last Modified:	13 Sep 2019 14:16
URI:	https://archive.lstmed.ac.uk/id/eprint/4923

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