Background
Methods
Ethical considerations
Study site/participants
Procedure and data collection tools
Analysis
Results
Yala (n = 97) | Bondob (n = 102) | Siaya (n = 108) | Total (N = 307) | |
---|---|---|---|---|
Agea | 28 (23–35) | 26 ( 23–32) | 26 (22–31) | 26 (23–32) |
Catchment | 21,999 | 42,506 | 44,195 | 108,700c |
Marital status [n (%)] | ||||
Married | 78 (80.4) | 85 (83.3) | 71 (65.7) | 234 (76.2) |
Single | 15 (15.5) | 13 (12.8) | 34 (31.5) | 62 (20.2) |
Divorced | 2 (2.1) | 1 (0.98) | 1 (0.9) | 4 (1.3) |
Separated | 0 | 2 (1.96) | 1 (0.9) | 3 (0.98) |
Widowed | 2 (2.1) | 1 (0.98) | 1 (0.9) | 4 (1.3) |
Parity | 2 (1–3) | 2 (1–3) | 1 (1–3) | 2 (1–3) |
Hospital deliveries [n (%)] | 91 (93.8) | 93 (91.1) | 97 (89.8) | 281 (91.5)d |
Education (≥ Primary education) [n (%)] | 96 (98.97) | 101 (99) | 107 (99.1) | 304 (99) |
Focus group participants [n (%)] | 26 (26.8) | 21 (20.6) | 20 (18.5) | 67 (21.8) |
Contextual factors
“Most pregnant mothers are teenagers and they hide the pregnancy until during birth where they deliver at home or on the roads or attempt abortions because they fear been known [sic] by parents.” Participant 5, FG5, Yala“Due to the increased early pregnancies in Siaya as a whole, some would fear hospitals, as they are young and not everyone will perceive them well…hence many will prefer home deliveries…” Participant 5, FG4, Siaya
“It (C-section) limits the number of pregnancies they can have. I hear you have to wait for a few years before trying to get pregnant again.” Participant 5, FG1, Siaya
“Some can only get 100 KSH [~ $1] a day and not guaranteed to get the same amount daily. Most people do not even have an income.” Participant 3, FG3, Yala“For an operation, they pay about 1,000 KSH [$10] for which most mothers cannot afford because they are unemployed.” Participant 4, FG1, Bondo
“The roads are not proper in all areas. There are places people have to walk. It’s rocky…they deliver on the road and end up calling people from homesteads for help (sighs).” Participant 1, FG2, Yala
“When there is fully grown maize in the plantations, insecurity is high because robbers stand around the roads.” Participant 3, FG4, Yala
“Improve the hygiene especially the beddings, delivery rooms, and kitchen conditions…the kitchen is just next to the morgue! (sighs)…and flies move from the morgue to the kitchen.” Participant 3, FG3, Siaya
“They sleep two or more in bed with their newborns and also share the ward with pediatric admissions.” Participant 4, FG5, Yala
“Nurses who attend to them at the hospital are very harsh and they also handle them badly. There are rumors of those who die when delivering at the hospitals.” Participant 3, FG 4, Siaya
“Now, there is an increase in the number of doctors and surgeons during operation, and also now there is new machine that have made the operations easier.” Participant 5, FG3, Siaya
Maternal factors
“Others just have a negative attitude and feel that there is nothing to gain in hospital. Some people are told that hospitals are not good.” Participant 5, FG2, Bondo“You will find people still seeking services of the traditional birth attendants due to lack of awareness. This is a rural area; hence people are not informed.” Participant 2, FG4, Siaya
“TBAs are close to homes of people, and the hospitals are quite far, so it is the only option pregnant mothers have.” Participant 5, FG5, Yala
“There are those mothers who fear going to the hospital because they fear being tested for HIV and do not want to know their status.” Participant 3, FG5, Yala“The TBAs are preferred because they do not test for HIV like in the hospital.” Participant 3, FG1, Bondo
“If you did not attend the antenatal clinics, then you come to the hospital in labor, the nurses will not attend to you. They let you deliver by yourself in the waiting area. Hence you will find many women shunning away from the hospital if they did not attend clinics during pregnancy.” Participant 2, FG2, Siaya
Delivery location
Home delivery
“The nurses in the hospital serve so many women, like about 20, and get exhausted, which make them harass mothers, but TBAs are good because they have only one mother at a time, which allows them to give full attention to mothers.” Participant 2, FG3, Bondo
“At times labor comes at night, and no one will take you to hospital late at night so they call on TBAs who are near the homes of these pregnant mothers.” Participant 2, FG3, Bondo
“These days TBAs have herbal treatment which when given they can change a baby's position if it is not correct, unlike in a hospital, where they do not have drugs to make the baby turn around in the stomach and the doctors will not know.” Participant 3, FG3, Bondo
“They can deliver the baby badly and the baby can die, or they may cut the cord in a bad way and that may cause a lot of problems, and also some bleed a lot and they have to be rushed to the hospital.” Participant 5, FG1, Siaya
“People also don’t prefer them (TBAs) because they will ask you for money.” Participant 1, FG1, Siaya
Hospital delivery
“Availability of drugs at the hospital to prevent infections during operation. In hospitals you find doctors and nurses who are here to help you in case of any problem.” Participant 1, FG1, Yala
“In hospital it is better because you are tested for HIV and if you are positive the baby will not get the virus at the hospital. If you go to the TBAs they will not test you for HIV.” Participant 4, FG3, Bondo
“These days, SVD (spontaneous vaginal delivery) is better, as most operations here are performed by students and interns who are not fully qualified. Someone was cut inappropriately through CS by a student.” Participant 5, FG4, Siaya