Women's autonomy and utilization of maternal health services in resource poor settings: a study of Gatwekera Village, Kibera Slums, Nairobi-Kenya
Onyango, Mollen A
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Utilization of maternal health care services could save unnecessary severe complications and death among women during pregnancy, delivery and after delivery. Numerous factors such as characteristics of the women and their family as well as characteristics of health care system including accessibility, acceptability, cost and quality of care contribute directly with the use of maternal health care. The purpose of this study was to establish the link between women's autonomy and utilization of maternal health services. Women's' autonomy in the study is defined as a woman's ability to make and execute decisions regarding personal matters of importance to her on the basis of her power over others, access to information, control over material resources and freedom from violence by her husband or other men. The variables used to determine women's autonomy in the study are decision making variables which includes; discretion over earnings, checking own health decision making related to economic matters, visiting relatives' etcetera, and freedom of movement variable which includes; going out recreation, visiting neighbors, visiting local health centers etcetera. The study was descriptive in nature and the data used in the study are primary data obtained in the field in Gatwekera village Kibera slums Nairobi. The study was guided by the following questions: 1) Does the effect of women's autonomy depends on household wealth? 2) Does women's autonomy influence the choice of place of delivery in urban poor resource settings? 3) To what extent does women's education mediate the relationship between women's autonomy and the use of health facility for delivery? The study employed purposive sampling through snow balling to get the required respondents. A total of 100 respondents were interviewed during the study. The final results show that the relationship between women's autonomy and utilization of maternal health services does not exist when it is measured using decision making and freedom of movement variables only. The results also showed that women's autonomy depends on household wealth to some extent. In this case Gatwekera village mainly consists of urban poor yet when their autonomy was measured using freedom of movement it was found to be strong. Women's autonomy does not contribute to choice of place of delivery in urban poor resource settings when education level is low. The findings showed that decision-making variables that were used in the study do not contribute to any extent the place the women choose to deliver. Even freedom of movement has not showed a direct relationship with the choice of place delivery. From the findings education does playa very important role in utilization of maternal health services. To make the study more exhaustive, concerning future research in this area, more attention needs to be given to developing better measures of women's autonomy at the household level. In terms of antenatal care more research should be done to address the timing and adequacy of antenatal care. The government should provide maternal health services in the slums as most of these services are provided by CBO, NGO and privately owned clinics. More mid- wives should be trained to solve the issue TBAs.