Utilization of maternal health care services in Kenya: A Case of Meru North District
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This study investigates the factors influencing the utilization of maternal health care services in Meru North District, Kenya. In this regard it addresses the following specific research objectives: First, to find out the various types of maternal health care services in Meru North District. Secondly, to assesses the level and differentials of the utilization of maternal health care services in the study area. The study investigates only two aspects of maternal health care. These include prenatal and delivery care. The study aimed at contributing (though in a small way) to the understanding of maternal health in the study area. To guide the study, specific hypotheses were developed and tested on the basis of the theoretical framework adopted from Kroeger (1983) and McKinley (1972) on health seeking behaviour. In this framework, Kroeger suggested that socio-economic and demographic factors, expected benefits from treatment, quality of care, availability of a health facility including the cost of transport as key variables in determining the decision to seek care. Cross tabulations and frequency distributions were applied with chi-square tests being used to determine the differentials in the utilization of maternal health care services. The study involved a survey of sixty women who had had a birth three years preceding the survey. In addition, eight key in-depth interviews involving local community members were conducted. The findings show that Meru North District lacks adequate maternal health care facilities and more particularly delivery services. It was observed that some women have to walk an insurmountable distance of over 25 kilometres to the nearest maternal health care facility. Furthermore, the few existing formal health facilities are concentrated in a few administrative divisions leaving some without a delivery health facility. Regarding the levels of utilization, the results indicate that prenatal care coverage in Meru North District stands at 90%, while delivery in a health facility was estimated at 43%. Results also indicate that both the trained and untrained health providers operate in the study area and playa key role in addressing maternal health. However, in- depth interviews .revealed that quality of care could only be assured from the trained providers. Quantitative results show' that utilization of maternal health care services varies significantly by maternal and paternal education; parity and maternal age. Qualitative results indicate that several factors were commonly associated with a home delivery, delays in seeking antenatal care, irregular attendance of the routine checks or total avoidance of prenatal care. These included: long distances to a health facility; negative provider attitudes; financial barriers; lack of information and understanding; gender inequalities; lack of decision making power by women. Some saw no need to use the services as pregnancy and childbirth are a natural process and one should only seek care when there are complications. Recognizing that the major reasons for under- utilization of maternal health care services in Meru North District are largely linked to socio-economic status of women, this study recommends that literacy and in particular female literacy should be promoted. This shall go along way in empowering women to take an active role not only in family decision making but also productively engage them in taking their rightful place in the community. Moreover, the government, civil society organizations, development partners and the community need to urgently address the identified obstacles to the utilization of services. For instance, the government should evolve a scheme for affordable maternal health care and particularly for delivery services. Finally, it would be worthwhile to investigate the whole idea of home delivery using a combination of approaches. These could involve targeting institutions providing delivery services and women in the reproductive age group to gain a deeper understanding on what can be done to make delivery safe in the face of many home deliveries.