Determinants Of The Choice Of Place Of Delivery Among Expectant Mothers In Kitui West Sub-County, Kitui County, Kenya

Abstract

This study explored ‘Determinants of the Choice of Place of Delivery among Expectant Mothers in Kitui West Sub-county’. Specifically, the study assessed pregnant women’s choice of place of delivery and reasons for their choice, determined where the pregnant women finally delivered and what influenced their choices. The third aspect was to find out opinions about pregnant women’s choice of place of delivery from caretakers who accompany pregnant women from pregnancy to childbirth. The caretakers included; nurses and traditional birth attendants (TBAs). The study was guided by Health Belief Model (Becker and Maiman, 1977), Autonomy Theory of Empowerment (Anderson, 2013) and the Predisposing Factors on Health Care Ultilization Model (Andersen, 1995). The study population comprised expectant women in their third trimester. One hundred and thirty five ANC-attendees were drawn from 10 randomly sampled health facilities in Kitui West Sub-county for the survey. Further, two Focus Group Discussions (FGDs) of 12 and 10 pregnant women were carried out within the 10 sampled health facilities. Besides, key informant interviews were held with eight TBAs and five nurses. This research was both qualitative and quantitative. Data was collected from the women regarding their perspectives on choice of place of delivery during pregnancy and after delivery to determine what informed their actual place of delivery. Quantitative data was captured into SPSS and descriptive and inferential statistics were used in analyzing data while qualitative data was captured into Nvivo, themes derived on the basis of study objectives, parental and child nodes derived as per the direction of responses. Presentation has been done on the basis of graphs and frequency tables including pie charts for quantitative data while verbatim quotes were used to amplify qualitative data. The findings indicate that out of 135 ANC-attendees, 93 percent had intended to deliver in a health facility, 2.2 percent had planned to deliver at home, and only about 1.5 percent were waiting for their husbands to decide their place of delivery. The remaining 3 percent were waiting on other relatives to decide on where they were to deliver. In regard to the 30 non-ANC-attendees, 60 percent of them had planned to deliver at home, 23 percent intended to deliver in a health facility, while 14 percent were undecided. The remaining 3 percent were waiting for their fathers to decide where to deliver. In relation to where these two groups of women actually delivered, 64 percent of 135 ANC-attendees delivered in a health facility while 36 percent delivered at home. Of the 30 non-ANC-attendees who were considered as a control group in this study, 90 percent delivered at home and 10 percent delivered in health facilities. Overall the key reasons of where the women delivered included awareness of complications that could occur during childbirth, complications during childbirth, confidence in the TBA, quick labour, previous complications during childbirth and influence of significant others on where the baby should be delivered. Previous safe deliveries emerged as the main reason for choosing to deliver at home for 30 non-ANC-attendees. Targeted sensitization on the value of health-facility-based deliveries should be rolled out to actors and/or chain of decision makers in an expectant woman’s life. Among these in Kitui West are; women at child bearing age, significant others who would include husbands, mothers-in-law, mothers of pregnant women and TBAs. This study recommends MoH to train TBAs in basic skills in order to give standardized maternal health care services. It also recommends a further research to explore why education attained did not influence place of delivery.