Background
Methods
Study setting
Quantitative data collection
Qualitative data collection
Analysis
Results
Participant characteristics
Participant characteristics | Number | Percent |
---|---|---|
Age | ||
13–19 | 93 | 18 |
20–29 | 211 | 40 |
30–39 | 158 | 30 |
40–49 | 61 | 12 |
Total | 523 | 100 |
Marital status | ||
Currently married | 408 | 78 |
Previously married | 58 | 11 |
Never married | 41 | 8 |
Unmarried but living with partner | 16 | 3 |
Total | 523 | 100 |
Religious background | ||
Christian | 8 | 2 |
Muslim | 515 | 98 |
Total | 523 | 100 |
Birth Preparedness
Quantitative findings
Items prepared | n/496 | Percent | 95 % CI |
---|---|---|---|
Cotton gauze | 460 | 93 | 90–95 |
Cover to deliver on | 418 | 84 | 81–87 |
Gloves | 359 | 72 | 67–77 |
Clean clothes | 267a
| 70 | 65–74 |
Money | 206 | 42 | 37–46 |
Razor | 86 | 17 | 14–21 |
Basin | 64 | 13 | 10–16 |
Soap | 56 | 11 | 8–15 |
Cord clamps or thread | 52 | 10 | 8–13 |
Bucket | 51 | 10 | 8–13 |
Uterotonic drugs | 26 | 5 | 3–8 |
Transport | 9 | 2 | 1–3 |
Identification of facility for delivery | 3 | 1 | 0–2 |
Qualitative findings
“In the hospital during service, if they ask you to bring gloves, you give them, bring a bucket, I give them, so services go well. [Interviewer: What could have happened if you did not have those items?] They could have refused to help me in the hospital.” (Mother, 38)
“You know nowadays there a lot of diseases, so if we use the same equipment there is a possibility of disease transmission.” (Mother, 44)
“[Without encouragement from the EQUIP volunteers] I could not have prepared myself because during the previous pregnancies you find all those things in the hospital. I couldn’t have known what to prepare—probably I would have carried a piece of khanga [cloth], thinking that all the services are available at the hospital.” (Mother, 39)
“It is possible there is a person whom you depend on, and [he] is poor. He doesn’t have money, like your parents [who are also poor], and the one who made you pregnant has rejected you, and if the parent has little capacity, that equipment [for birth] won’t be available.” (Mother, 19)
“I planned to buy those things when I got money, but I felt labour pain without finishing doing delivery preparations, so I went to the hospital and got all the needed things there.” (Mother, 24)
“I won’t prepare, rather, I will save money. I will just buy things at the hospital in case there are things that I will be asked to buy. I already know all things are sold there.” (Father, 32)
Place of delivery
Quantitative findings
Place of delivery | n/N | Percent | 95 % CI | Birth preparations made (n/N) | Percent | 95 % CI |
---|---|---|---|---|---|---|
Hospital | 164/526 | 31 | 25–38 | 161/163 | 99 | 95–100 |
Health Centre | 50/526 | 10 | 6–15 | 50/50 | 100 | 100 |
Dispensary | 144/156 | 27 | 22–33 | 142/144 | 99 | 94–100 |
Home | 156/526 | 30 | 25–35 | 132/154 | 86 | 78–91 |
Other | 12/156 | 2 | 1–4 | 11/12 | 92 | 56–99 |
Qualitative findings
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increased education of mothers and fathers about maternal and newborn health, both received at health facilities during antenatal care, but also from village volunteers like those from EQUIP;“I received education for my second child. Now they don’t allow anyone to deliver at home. Most of us now go to the hospital for delivery.” (Mother, 25)
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special efforts being made to sensitise women who are young or primiparous or have had five or more children about the necessity of them delivering in a hospital due to their increased risk of complications;“They said that this is the fifth pregnancy, once the person reaches the fifth pregnancy they should go to the hospital.” (Mother, 35)
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women having previously experienced complications and therefore understanding the importance of health facility delivery;“[For the first pregnancy] the baby was too big, so they enlarged her birth canal [gave her an episiotomy]—that couldn’t be done at home … [Because] I saw that the first pregnancy had developed complications…I told [my wife] to prepare herself to go to the hospital.” (Father, 35)
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women generally having positive experiences at the health facility and choosing to return for future births;“I have seen great success in my first pregnancy; I didn’t face any problems…they followed up and I did listen to them…I have seen its importance.” (Mother, 19)
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the prohibition of homebirths in some villages often through the use of fines for mothers or for traditional birth attendants who may be assisting them—established by village leaders or by volunteers like those in EQUIP as part of their strategies—or the refusal of services by local health facility staff (see Tancred et al. for more detail on this point [19]);“But if you deliver at home [then] at the time you go to facility, they refuse to attend you, other staff may even refuse to give you a card.” (Mother, 19)
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an increased number of facilities and more reliable modes of transportation, namely motorbikes.“[Health facilities] were few, and we used to go for long distances and there was no reliable transport. People used to carry pregnant women on a bicycle or in a basket and take them to hospital, but now if labour pains start they take them faster using motorbikes.” (Mother, 38)
“I was alone…My husband was not around and my children were at school, it was around two…on the way back from school, my child went to tell his father in order to find transport…When my husband arrived with transport I had already delivered.” (Mother, 29)
“I was alone…I didn’t intend to [give birth at home], I didn’t know [I was in labour] and I stayed for a long time…My husband left enough money—when he travelled he left me one hundred thousand shillings [~64 USD].” (Mother, 24)
“The labour pain started and we sent her there [to the dispensary], but there was no one to attend her … The problem is, there are only two staff, and if they [leave], this facility remains with no one.” (Father, 40)
“The nurse just throws the patient on the bed, until the one who has come to look after the patient follows the nurse and asks her to go and look at her patient but she doesn’t and she says, ‘I feel sleepy, I am going to sleep’. So she goes to call the traditional birth attendant in the village to help with the birth [instead].” (Mother, 35)
“There are changes because nowadays there is the use of services professionally, and mothers are educated and they go to deliver at the health facility. Nowadays to give birth at home is an emergency.” (Mother, 39)
“Others might have no money. Another problem is she might have no one to take her to the health facility. Some are single mothers. Some…women are rejected, while others do not have relatives to help them.” (Mother, 30)