Background
Methods
Setting
Data sources
Surveys with women
Focus group discussions (FGDs) with women
In-depth interviews with providers
Measures for quantitative analysis
Dependent (outcome) variables
Variable | Description |
---|---|
Availability of a companion | Whether or not someone accompanied the woman from home to the health facility. In addition, we asked if this person stayed with them during labor, delivery, and/or after delivery. |
Type of companion | Relationship to the person who accompanied them to the facility. Women were allowed to mention more than one person, and thus, the preferred companion analysis is based on whether or not a particular type of person was mentioned. |
Allowed continuous support during labor | Whether or not they were allowed to have someone they wanted to stay with them during labor. A response of “yes, most of the time,” or “yes, all the time” is coded as being allowed continuous labor support, and “no, never” or “yes, a few times” is coded as not being allowed continuous labor support. |
Allowed continuous support during delivery | Whether they were allowed to have someone they wanted to stay with them during delivery. Recoded similarly to “allowed continuous support during labor” |
Desire for companionship during labor, delivery, and after delivery | Whether or not they wanted the person who accompanied them to stay with them during labor, delivery, and/or after delivery; and if they will want a companion at each stage if they were to have another baby in the future |
Preferred type of companion | The type of person they would want as a companion during labor, delivery, and/or after delivery if they were to have another baby. They could mention more than one person, so responses refer to whether or not they mentioned a particular type of person |
Independent variables
Data analysis
Quantitative analysis
Qualitative analysis
Results
Results from interviews with women
Univariate distributions
Survey respondents | FGD respondents | |||
---|---|---|---|---|
No. | % | No. | % | |
Total N | 877 | 100.0 | 58 | 100 |
Age | ||||
15 to 19 years | 162 | 18.5 | 4 | 6.9 |
20 to 29 years | 511 | 58.3 | 38 | 65.5 |
30 to 48 years | 204 | 23.3 | 16 | 27.6 |
Marital status | ||||
Single | 140 | 16.0 | 5 | 8.6 |
Partnered/Cohabiting | 3 | 0.3 | 1 | 1.7 |
Married | 687 | 78.3 | 51 | 87.9 |
Widowed | 35 | 4.0 | 1 | 1.7 |
Divorced/Separated | 12 | 1.4 | ||
Number of births | ||||
1.0 | 290 | 33.1 | 6 | 10.3 |
2.0 | 185 | 21.1 | 8 | 13.8 |
3.0 | 163 | 18.6 | 11 | 19 |
4 or more | 239 | 27.3 | 33 | 56.9 |
Education | ||||
No school/Primary | 495 | 56.4 | 46 | 79.3 |
Post-primary/Vocational/Secondary | 271 | 30.9 | 10 | 17.2 |
College or above | 111 | 12.7 | 2 | 3.4 |
Literacy: writing | ||||
No, cannot write | 31 | 3.5 | 1 | 1.7 |
Yes, but with some difficulty | 141 | 16.1 | 38 | 65.5 |
Yes, Very well | 705 | 80.4 | 19 | 32.8 |
Literacy: reading | ||||
No, cannot read | 37 | 4.2 | 4 | 6.9 |
Yes, but with some difficulty | 129 | 14.7 | 34 | 58.6 |
Yes, Very well | 711 | 81.1 | 20 | 34.5 |
Employed | ||||
No | 658 | 75.0 | 39 | 67.2 |
Yes | 219 | 25.0 | 19 | 32.8 |
Wealth Quintile | ||||
Poorest | 190 | 21.7 | ||
Poorer | 190 | 21.7 | ||
Middle | 135 | 15.4 | ||
Richer | 172 | 19.6 | ||
Richest | 190 | 21.7 | ||
Delivery facility type | ||||
Gov’t Hospital | 404 | 46.1 | 27 | 49.1 |
Gov’t Health Center | 362 | 41.3 | 23 | 41.8 |
Mission/Private facility | 111 | 12.7 | 5 | 9.1 |
Delivery provider | ||||
Nurse/Midwife | 656 | 74.8 | ||
Doctor | 83 | 9.5 | ||
Clinical Officer | 54 | 6.2 | ||
Non-skilled attendant | 21 | 2.4 | ||
1plus skilled providers | 63 | 7.2 | ||
Delivery Provider sex | ||||
Male | 329 | 37.5 | ||
Female | 514 | 58.6 | ||
Both | 34 | 3.9 | ||
Labor/Delivery complications | ||||
No | 721 | 82.21 | ||
Yes | 156 | 17.79 | ||
Past facility delivery | ||||
No | 342 | 39.0 | 11 | 19 |
Yes | 535 | 61.0 | 47 | 81 |
Trimester of first ANC | ||||
First trimester | 261 | 29.8 | ||
Second trimester | 536 | 61.3 | ||
Third Trimester | 72 | 8.2 | ||
No ANC | 6 | 0.7 | ||
Number of ANC visits | ||||
No ANC | 6 | 0.7 | ||
Less than 4 | 281 | 32.2 | ||
4 or 5 | 485 | 55.6 | ||
6 plus | 100 | 11.5 | ||
Tribe | ||||
Luo | 584 | 66.6 | 38 | 65.5 |
Kuria | 208 | 23.7 | 12 | 20.7 |
Other | 85 | 9.7 | 8 | 13.8 |
Religion | ||||
Catholic | 242 | 27.6 | 12 | 20.7 |
Protestant/Pentecostal | 191 | 21.8 | 22 | 37.9 |
Seventh Day Adventist | 263 | 30.0 | 14 | 24.1 |
Other Christian | 166 | 18.9 | 7 | 12.1 |
Muslim/other religion | 15 | 1.7 | 3 | 5.2 |
Postpartum length | ||||
Less than 1 week | 75 | 8.6 | 1 | 1.7 |
1 week or more | 802 | 91.4 | 57 | 98.3 |
Place of Interview | ||||
Health facility | 356 | 40.6 | 10 | 17.2 |
In the community/a home | 521 | 59.4 | 48 | 82.8 |
Birth Companionship Variables | No. | % | No. | % | No. | % |
---|---|---|---|---|---|---|
Accompanied from home to facility | ||||||
No | 106 | 12.4 | ||||
Yes | 751 | 87.6 | ||||
Accompanied by | ||||||
Partner-Husband | 251 | 29.3 | ||||
Mother-in-law | 236 | 27.5 | ||||
Mother | 100 | 11.7 | ||||
Sister/Sister-in-law | 164 | 19.1 | ||||
Friend/Neighbor | 112 | 13.1 | ||||
Other a | 74 | 8.7 | ||||
Companion stayed during | Labor | Delivery | Post-delivery | |||
No | 157 | 20.9 | 556 | 74 | 86 | 11.5 |
Yes | 588 | 78.3 | 192 | 25.6 | 661 | 88 |
Don’t know | 6 | 0.8 | 3 | 0.4 | 4 | 0.5 |
Companion allowed during | Labor | Delivery | ||||
No, never | 162 | 18.9 | 524 | 61.1 | ||
Yes, a few times | 103 | 12 | 72 | 8.4 | ||
Yes, most of the time | 230 | 26.8 | 110 | 12.8 | ||
Yes, all the time | 357 | 41.7 | 138 | 16.1 | ||
Wanted Companion to stay during | Labor | Delivery | Post-delivery | |||
No | 138 | 18.4 | 476 | 63.4 | 48 | 6.4 |
Yes | 608 | 81 | 267 | 35.6 | 701 | 93.3 |
Don’t know | 5 | 0.7 | 8 | 1.1 | 2 | 0.3 |
Will want companion in future during | Labor | Delivery | Post-delivery | |||
No | 285 | 33.3 | 592 | 69.1 | 85 | 9.9 |
Yes | 560 | 65.3 | 254 | 29.6 | 761 | 88.8 |
Don’t know | 12 | 1.4 | 11 | 1.3 | 11 | 1.3 |
Preferred companion type in future during | Labor | Delivery | Post-delivery | |||
Partner-Husband | 188 | 21.9 | 49 | 5.7 | 370 | 43.2 |
Mother in Law | 234 | 27.3 | 119 | 13.9 | 362 | 42.2 |
Mother | 91 | 10.6 | 42 | 4.9 | 138 | 16.1 |
Sister/Sister in law | 165 | 19.3 | 63 | 7.4 | 244 | 28.5 |
Friend/Neighbor | 77 | 9 | 31 | 3.6 | 159 | 18.6 |
Community Health Volunteer | 4 | 0.5 | 4 | 0.5 | 8 | 0.9 |
Nurse/Midwife | 35 | 4.1 | 21 | 2.5 | 49 | 5.7 |
Doctor | 10 | 1.2 | 10 | 1.2 | 14 | 1.6 |
Other | 23 | 2.7 | 8 | 0.9 | 26 | 3 |
Acceptability of being denied a companion | ||||||
Unacceptable in all instances | 722 | 84.2 | ||||
Acceptable in certain instances | 112 | 13.1 | ||||
Acceptable in all instances | 23 | 2.7 | ||||
Total | 857 | 100 | 857 | 100 | 857 | 100 |
Bivariate results
Accompanied to facility | Allowed continuous support during | |||||
---|---|---|---|---|---|---|
Labor | Delivery | |||||
No. | % | No. | % | No. | % | |
Age | ||||||
15 to 19 years | 156 | 96.3** | 118 | 72.8 | 58 | 35.8 |
20 to 29 years | 442 | 86.5 | 352 | 69.2 | 153 | 29.9 |
30 to 48 years | 172 | 84.3 | 130 | 63.7 | 56 | 27.5 |
Marital Status | ||||||
Not married | 172 | 90.5 | 137 | 72.1 | 69 | 36.3* |
Currently married | 598 | 87 | 463 | 67.6 | 198 | 28.8 |
Number of births | ||||||
1.0 | 274 | 94.5*** | 216 | 74.5** | 102 | 35.2 |
2.0 | 163 | 88.1 | 134 | 73.2 | 51 | 27.6 |
3.0 | 137 | 84 | 103 | 63.2 | 53 | 32.5 |
4 or more | 196 | 82 | 147 | 61.5 | 61 | 25.5 |
Education | ||||||
No school/Primary | 425 | 85.9 | 323 | 65.4* | 132 | 26.7* |
Post-primary/vocational/Secondary | 246 | 90.8 | 189 | 70 | 99 | 36.5 |
College or above | 99 | 89.2 | 88 | 79.3 | 36 | 32.4 |
Literacy | ||||||
No, cannot write | 28 | 90.3 | 13 | 41.9*** | 7 | 22.6*** |
Yes, but with some difficulty | 122 | 86.5 | 84 | 59.6 | 20 | 14.2 |
Yes, Very well | 620 | 87.9 | 503 | 71.6 | 240 | 34 |
Household wealth | ||||||
Poorest/poorer | 332 | 87.4 | 236 | 62.3** | 105 | 27.6* |
Middle | 122 | 90.4 | 93 | 68.9 | 37 | 27.4 |
Richer/richest | 316 | 87.3 | 271 | 75.1 | 125 | 34.5 |
Employed | ||||||
No | 576 | 87.5 | 427 | 65.1*** | 198 | 30.1 |
Yes | 194 | 88.6 | 173 | 79 | 69 | 31.5 |
Pregnancy complication | ||||||
No | 431 | 87.2 | 349 | 70.8 | 168 | 34** |
Yes | 339 | 88.5 | 251 | 65.7 | 99 | 25.8 |
Birth Complication | ||||||
No | 633 | 87.8 | 515 | 71.6*** | 242 | 33.6*** |
Yes | 137 | 87.8 | 85 | 54.5 | 25 | 16 |
Past health facility delivery | ||||||
No | 315 | 92.1** | 242 | 70.8 | 117 | 34.2 |
Yes | 455 | 85 | 358 | 67.2 | 150 | 28 |
ANC visits | ||||||
Less than 4 | 240 | 83.6** | 200 | 69.7 | 92 | 32.1 |
4 plus | 526 | 89.9 | 396 | 67.8 | 173 | 29.6 |
Tribe | ||||||
Luo | 496 | 84.9*** | 426 | 73.1*** | 189 | 32.4 |
Kuria | 200 | 96.2 | 117 | 56.5 | 53 | 25.5 |
Other | 74 | 87.1 | 57 | 67.1 | 25 | 29.4 |
Religion | ||||||
Catholic | 215 | 88.8 | 175 | 72.6 | 68 | 28.1 |
Protestant/Pentecostal | 165 | 86.4 | 122 | 63.9 | 53 | 27.7 |
Seventh Day Adventist | 236 | 89.7 | 182 | 69.5 | 94 | 35.7 |
Other Christian | 142 | 85.5 | 112 | 67.5 | 46 | 27.7 |
Muslim/other religion | 12 | 80 | 9 | 60 | 6 | 40 |
Delivery facility type | ||||||
Gov’t Hospital | 369 | 91.3** | 257 | 63.9** | 115 | 28.5 |
Gov’t Health Center | 303 | 83.7 | 273 | 75.4 | 114 | 31.5 |
Mission/Private facility | 98 | 88.3 | 70 | 63.1 | 38 | 34.2 |
Delivery provider | ||||||
Nurse/Midwife | 578 | 88.1 | 462 | 70.6** | 209 | 31.9 |
Doctor/Clinical Officer | 119 | 86.9 | 89 | 65 | 40 | 29.2 |
Non-skilled attendant | 17 | 81 | 17 | 81 | 8 | 38.1 |
1plus skilled providers | 56 | 88.9 | 32 | 50.8 | 10 | 15.9 |
Delivery Provider sex | ||||||
Male | 294 | 89.4 | 206 | 62.6* | 82 | 24.9* |
Female | 445 | 86.6 | 370 | 72.3 | 173 | 33.7 |
Both | 31 | 91.2 | 24 | 70.6 | 12 | 35.3 |
Accompanied by | ||||||
Partner | ||||||
No | 434 | 69.7 | 208 | 33.3** | ||
Yes | 166 | 65.9 | 59 | 23.3 | ||
Mother-in-law | ||||||
No | 442 | 70 | 186 | 29.4 | ||
Yes | 158 | 64.8 | 81 | 33.1 | ||
Mother | ||||||
No | 525 | 67.9 | 231 | 29.8 | ||
Yes | 75 | 73.5 | 36 | 35.3 | ||
Sister/Sister in law | ||||||
No | 465 | 65.7*** | 223 | 31.4 | ||
Yes | 135 | 80.8 | 44 | 26.3 | ||
Friend/Neighbor | ||||||
No | 519 | 68.2 | 238 | 31.2 | ||
Yes | 81 | 71.1 | 29 | 25.4 | ||
Facility crowded | ||||||
No or a few times | 425 | 72.2** | 172 | 29.1 | ||
Most or all the time | 173 | 60.9 | 94 | 33.1 | ||
Desired labor companion | ||||||
No | 68 | 47.9*** | ||||
Yes | 459 | 73.9 | ||||
Don’t know | 3 | 60 | ||||
Desired delivery companion | ||||||
No | 92 | 18.8*** | ||||
Yes | 135 | 49.6 | ||||
Don’t know | 4 | 50 | ||||
Total | 770 | 87.8 | 600 | 68.6 | 267 | 30.4 |
Desire for labor support | Desire for delivery support | |||||||
---|---|---|---|---|---|---|---|---|
Last birth | Future birth | Last birth | Future birth | |||||
No. | % | No. | % | No. | % | No. | % | |
Age | ||||||||
15 to 19 years | 128 | 82.1 | 108 | 66.7* | 73 | 46.8* | 58 | 35.8 |
20 to 29 years | 352 | 79.6 | 327 | 64 | 144 | 32.6 | 137 | 26.9 |
30 to 48 years | 142 | 82.6 | 139 | 68.1 | 55 | 32 | 62 | 30.4 |
Marital Status | ||||||||
Not married | 149 | 86.6 | 125 | 65.8** | 81 | 47.1** | 65 | 34.2* |
Currently married | 473 | 79.1 | 449 | 65.4 | 191 | 31.9 | 192 | 28 |
Number of births | ||||||||
1.0 | 233 | 85 | 190 | 65.5 | 122 | 44.5** | 108 | 37.2* |
2.0 | 134 | 82.2 | 132 | 71.4 | 55 | 33.7 | 51 | 27.7 |
3.0 | 105 | 76.6 | 103 | 63.2 | 38 | 27.7 | 37 | 22.7 |
4 or more | 150 | 76.5 | 149 | 62.3 | 57 | 29.1 | 61 | 25.5 |
Education | ||||||||
No school/Primary | 336 | 79.1 | 321 | 64.8 | 137 | 32.2 | 141 | 28.5 |
Post-primary/Vocational/Secondary | 202 | 82.1 | 182 | 67.2 | 99 | 40.2 | 78 | 28.8 |
College or above | 84 | 84.8 | 71 | 64 | 36 | 36.4 | 38 | 34.2 |
Literacy | ||||||||
No, cannot write | 22 | 78.6 | 22 | 71 | 9 | 32.1* | 6 | 19.4 |
Yes, but with some difficulty | 94 | 77 | 98 | 69.5 | 28 | 23 | 38 | 27 |
Yes, Very well | 506 | 81.6 | 454 | 64.4 | 235 | 37.9 | 213 | 30.3 |
Household wealth | ||||||||
Poorest/poorer | 260 | 78.3 | 251 | 66.1 | 103 | 31** | 104 | 27.4 |
Middle | 98 | 80.3 | 86 | 63.7 | 39 | 32 | 33 | 24.4 |
Richer/richest | 264 | 83.5 | 237 | 65.5 | 130 | 41.1 | 120 | 33.1 |
Employed | ||||||||
No | 452 | 78.5* | 402 | 61.1*** | 200 | 34.7 | 184 | 28 |
Yes | 170 | 87.6 | 172 | 78.5 | 72 | 37.1 | 73 | 33.3 |
Pregnancy complication | ||||||||
No | 346 | 80.3 | 309 | 62.6* | 149 | 34.6 | 144 | 29.1 |
Yes | 276 | 81.4 | 265 | 69.2 | 123 | 36.3 | 113 | 29.6 |
Birth Complication | ||||||||
No | 517 | 81.7 | 468 | 64.9 | 224 | 35.4 | 210 | 29.2 |
Yes | 105 | 76.6 | 106 | 67.9 | 48 | 35 | 47 | 30.1 |
Past health facility delivery | ||||||||
No | 265 | 84.1 | 225 | 65.8 | 140 | 44.4*** | 122 | 35.7** |
Yes | 357 | 78.5 | 349 | 65.2 | 132 | 29 | 135 | 25.3 |
ANC visits | ||||||||
Less than 4 | 196 | 81.7 | 190 | 66.2 | 86 | 35.8 | 91 | 31.8 |
4 plus | 423 | 80.4 | 380 | 65 | 183 | 34.8 | 163 | 27.9 |
Tribe | ||||||||
Luo | 407 | 82.1 | 370 | 63.4 | 167 | 33.7 | 143 | 24.5*** |
Kuria | 160 | 80 | 146 | 70.2 | 71 | 35.5 | 79 | 38 |
Other | 55 | 74.3 | 58 | 68.2 | 34 | 45.9 | 35 | 41.2 |
Religion | ||||||||
Catholic | 180 | 83.7 | 155 | 64 | 73 | 34 | 72 | 29.8** |
Protestant/Pentecostal | 129 | 78.2 | 125 | 65.4 | 72 | 43.6 | 77 | 40.5 |
Seventh Day Adventist | 196 | 83.1 | 184 | 70 | 79 | 33.5 | 73 | 27.8 |
Other Christian | 108 | 76.1 | 102 | 61.4 | 44 | 31 | 33 | 19.9 |
Muslim/other religion | 9 | 75 | 8 | 53.3 | 4 | 33.3 | 2 | 13.3 |
Delivery facility type | ||||||||
Gov’t Hospital | 294 | 79.7 | 256 | 63.4 | 133 | 36 | 130 | 32.3 |
Gov’t Health Center | 251 | 82.8 | 248 | 68.5 | 100 | 33 | 89 | 24.6 |
Mission/Private facility | 77 | 78.6 | 70 | 63.1 | 39 | 39.8 | 38 | 34.2 |
Delivery provider | ||||||||
Nurse/Midwife | 472 | 81.7 | 438 | 66.8 | 211 | 36.5 | 203 | 31 |
Doctor/Clinical Officer | 94 | 79 | 84 | 61.3 | 35 | 29.4 | 29 | 21.2 |
Non-skilled attendant | 13 | 76.5 | 14 | 66.7 | 6 | 35.3 | 6 | 28.6 |
1plus skilled providers | 43 | 76.8 | 38 | 60.3 | 20 | 35.7 | 19 | 30.2 |
Delivery Provider sex | ||||||||
Male | 235 | 79.9 | 215 | 65.3 | 108 | 36.7 | 104 | 31.6 |
Female | 363 | 81.6 | 337 | 65.6 | 152 | 34.2 | 141 | 27.5 |
Both | 24 | 77.4 | 22 | 64.7 | 12 | 38.7 | 12 | 35.3 |
Accompanied by | ||||||||
Partner | ||||||||
No | 443 | 85.7*** | 412 | 66 | 209 | 40.4*** | 195 | 31.3* |
Yes | 179 | 70.8 | 162 | 64 | 63 | 24.9 | 62 | 24.5 |
Mother-in-law | ||||||||
No | 419 | 79.8 | 401 | 63.4 | 180 | 34.3 | 168 | 26.6* |
Yes | 203 | 82.9 | 173 | 70.6 | 92 | 37.6 | 89 | 36.5 |
Mother | ||||||||
No | 534 | 79.9 | 504 | 65* | 224 | 33.5* | 221 | 28.6 |
Yes | 88 | 86.3 | 70 | 68.6 | 48 | 47.1 | 36 | 35.3 |
Sister/Sister in law | ||||||||
No | 476 | 78.9* | 456 | 64.2 | 212 | 35.2 | 206 | 29.1 |
Yes | 146 | 87.4 | 118 | 70.7 | 60 | 35.9 | 51 | 30.5 |
Friend/Neighbor | ||||||||
No | 532 | 81.1 | 504 | 66.1 | 222 | 33.8* | 222 | 29.1 |
Yes | 90 | 78.9 | 70 | 61.4 | 50 | 43.9 | 35 | 30.7 |
Facility crowded | ||||||||
No or a few times | 428 | 83.4* | 400 | 67.7 | 185 | 36.1 | 174 | 29.4 |
Most or all the time | 192 | 75.3 | 172 | 60.6 | 86 | 33.7 | 82 | 28.9 |
Allowed continuous labor support | ||||||||
No or a few times | 162 | 68.1*** | 146 | 53.1*** | ||||
Most or all the time | 459 | 86.6 | 428 | 71.3 | ||||
Allowed continuous delivery support | ||||||||
No or a few times | 137 | 25.4*** | 139 | 22.8*** | ||||
Most or all the time | 135 | 58.4 | 118 | 44.2 | ||||
Total | 622 | 80.8 | 574 | 65.5 | 272 | 35.3 | 257 | 29.3 |
Accompanied by Partner | Accompanied by mother-in-law | |||||
---|---|---|---|---|---|---|
No. | % | p-value | No. | % | p-value | |
Age | ||||||
15 to 19 years | 26 | 16 | *** | 43 | 26.5 | |
20 to 29 years | 154 | 30.1 | 150 | 29.4 | ||
30 to 48 years | 73 | 35.8 | 52 | 25.5 | ||
Marital Status | ||||||
Not married | 12 | 6.3 | *** | 21 | 11.1 | *** |
Currently married | 241 | 35.1 | 224 | 32.6 | ||
Number of births | ||||||
1.0 | 57 | 19.7 | *** | 67 | 23.1 | * |
2.0 | 70 | 37.8 | 62 | 33.5 | ||
3.0 | 50 | 30.7 | 53 | 32.5 | ||
4 or more | 76 | 31.8 | 63 | 26.4 | ||
Education | ||||||
No school/Primary | 117 | 23.6 | *** | 150 | 30.3 | * |
Post-primary/vocational/Secondary | 86 | 31.7 | 76 | 28 | ||
College or above | 50 | 45 | 19 | 17.1 | ||
Literacy | ||||||
No, cannot write | 11 | 35.5 | 11 | 35.5 | ||
Yes, but with some difficulty | 39 | 27.7 | 40 | 28.4 | ||
Yes, Very well | 203 | 28.8 | 194 | 27.5 | ||
Household wealth | ||||||
Poorest/poorer | 93 | 24.5 | * | 135 | 35.5 | *** |
Middle | 40 | 29.6 | 33 | 24.4 | ||
Richer/richest | 120 | 33.1 | 77 | 21.3 | ||
Employed | ||||||
No | 176 | 26.7 | * | 177 | 26.9 | |
Yes | 77 | 35.2 | 68 | 31.1 | ||
Has Health Insurance | ||||||
No | 175 | 24.2 | *** | 207 | 28.7 | |
Yes | 78 | 50.3 | 38 | 24.5 | ||
Pregnancy complication | ||||||
No | 149 | 30.2 | 131 | 26.5 | ||
Yes | 104 | 27.2 | 114 | 29.8 | ||
Birth Complication | ||||||
No | 204 | 28.3 | 202 | 28 | ||
Yes | 49 | 31.4 | 43 | 27.6 | ||
Past health facility delivery | ||||||
No | 68 | 19.9 | *** | 83 | 24.3 | |
Yes | 185 | 34.6 | 162 | 30.3 | ||
ANC visits | ||||||
Less than 4 | 58 | 20.2 | *** | 85 | 29.6 | |
4 plus | 192 | 32.8 | 158 | 27 | ||
Tribe | ||||||
Luo | 176 | 30.1 | 114 | 19.5 | *** | |
Kuria | 53 | 25.5 | 114 | 54.8 | ||
Other | 24 | 28.2 | 17 | 20 | ||
Religion | ||||||
Catholic | 72 | 29.8 | 68 | 28.1 | ||
Protestant/Pentecostal | 46 | 24.1 | 59 | 30.9 | ||
Seventh Day Adventist | 84 | 31.9 | 75 | 28.5 | ||
Other Christian | 48 | 28.9 | 39 | 23.5 | ||
Muslim/other religion | 3 | 20 | 4 | 26.7 | ||
Delivery facility type | ||||||
Gov’t Hospital | 120 | 29.7 | 122 | 30.2 | ||
Gov’t HC/Disp | 94 | 26 | 96 | 26.5 | ||
Mission/Private facility | 39 | 35.1 | 27 | 24.3 | ||
Delivery provider | ||||||
Nurse/Midwife | 190 | 29 | 188 | 28.7 | ||
Doctor/Clinical Officer | 40 | 29.2 | 35 | 25.5 | ||
Non-skilled attendant | 6 | 28.6 | 5 | 23.8 | ||
1plus skilled providers | 17 | 27 | 17 | 27 | ||
Delivery Provider sex | ||||||
Male | 100 | 30.4 | 97 | 29.5 | ||
Female | 142 | 27.6 | 138 | 26.8 | ||
Both | 11 | 32.4 | 10 | 29.4 | ||
Total | 253 | 28.8 | 245 | 27.9 |
Multivariate results
Allowed Continuous support during | ||||||
---|---|---|---|---|---|---|
Labor | Delivery | |||||
OR | 95% CI | OR | 95% CI | |||
Age | ||||||
15 to 19 years | 1 | [1 | 1] | 1 | [1 | 1] |
20 to 29 years | 0.79 | [0.46 | 1.35] | 0.86 | [0.50 | 1.47] |
30 to 48 years | 0.74 | [0.36 | 1.54] | 0.92 | [0.43 | 1.95] |
Currently married | 1.35 | [0.79 | 2.29] | 0.98 | [0.57 | 1.69] |
Number of births | ||||||
1 | 1 | [1 | 1] | 1 | [1 | 1] |
2 | 0.61 | [0.26 | 1.43] | 1.24 | [0.51 | 3.04] |
3 | 0.37* | [0.15 | 0.95] | 2.06 | [0.77 | 5.50] |
4 or more | 0.39 | [0.15 | 1.01] | 1.45 | [0.53 | 3.93] |
Education | ||||||
No school/Primary | 1 | [1 | 1] | 1 | [1 | 1] |
Post-primary/vocational/Secondary | 0.73 | [0.47 | 1.14] | 1.27 | [0.83 | 1.96] |
College or above | 0.75 | [0.36 | 1.56] | 1.21 | [0.61 | 2.39] |
Literacy | ||||||
No, cannot write | 1 | [1 | 1] | 1 | [1 | 1] |
Yes, but with some difficulty | 1.9 | [0.72 | 5.05] | 0.73 | [0.22 | 2.42] |
Yes, very well | 2.89* | [1.13 | 7.37] | 1.92 | [0.63 | 5.90] |
Household wealth | ||||||
Poorest/poorer | 1 | [1 | 1] | 1 | [1 | 1] |
Middle | 1.73* | [1.04 | 2.90] | 0.81 | [0.47 | 1.40] |
Richer/richest | 1.91** | [1.20 | 3.03] | 1.16 | [0.74 | 1.84] |
Employed | 1.97** | [1.24 | 3.12] | 0.91 | [0.58 | 1.42] |
Past health facility delivery | 2.19* | [1.05 | 4.57] | 0.71 | [0.32 | 1.58] |
4plus ANC visits | 0.68 | [0.46 | 1.01] | 0.82 | [0.56 | 1.20] |
Birth Complication | 0.67 | [0.43 | 1.04] | 0.34*** | [0.19 | 0.60] |
Tribe | ||||||
Luo | 1 | [1 | 1] | 1 | [1 | 1] |
Kuria | 0.57* | [0.37 | 0.90] | 0.79 | [0.48 | 1.29] |
Other | 0.79 | [0.44 | 1.43] | 0.79 | [0.43 | 1.45] |
Religion | ||||||
Catholic | 1 | [1 | 1] | 1 | [1 | 1] |
Protestant/Pentecostal | 0.68 | [0.41 | 1.12] | 1.06 | [0.62 | 1.79] |
Seventh Day Adventist | 0.7 | [0.44 | 1.12] | 1.55 | [0.99 | 2.44] |
Other Christian | 0.79 | [0.46 | 1.35] | 0.93 | [0.54 | 1.59] |
Muslim/other religion | 0.86 | [0.21 | 3.44] | 1.8 | [0.43 | 7.52] |
Delivery facility type | ||||||
Gov’t Hospital | 1 | [1 | 1] | 1 | [1 | 1] |
Gov’t Health Center | 1.98*** | [1.32 | 2.97] | 1.46 | [0.98 | 2.17] |
Mission/Private facility | 0.86 | [0.49 | 1.51] | 1.67 | [0.95 | 2.95] |
Delivery provider | ||||||
Nurse/Midwife | 1 | [1 | 1] | 1 | [1 | 1] |
Doctor/Clinical Officer | 0.8 | [0.46 | 1.39] | 1.13 | [0.63 | 2.00] |
Non-skilled attendant | 1 | [0.28 | 3.60] | 0.88 | [0.28 | 2.79] |
1plus skilled providers | 0.27** | [0.12 | 0.63] | 0.19** | [0.060 | 0.59] |
Delivery Provider sex | ||||||
Male | 1 | [1 | 1] | 1 | [1 | 1] |
Female | 1.24 | [0.82 | 1.89] | 1.42 | [0.92 | 2.19] |
Both | 4.68** | [1.54 | 14.2] | 5.40** | [1.67 | 17.5] |
Accompanied by | ||||||
Partner | 0.81 | [0.53 | 1.24] | 0.61* | [0.39 | 0.97] |
Mother-in-law | 0.92 | [0.59 | 1.44] | 1.19 | [0.74 | 1.91] |
Mother | 1.3 | [0.70 | 2.42] | 1.01 | [0.54 | 1.90] |
Sister/Sister in law | 1.85* | [1.13 | 3.01] | 0.73 | [0.45 | 1.18] |
Friend- Neighbor | 0.87 | [0.51 | 1.46] | 0.61 | [0.35 | 1.06] |
Facility crowded | 0.65* | [0.45 | 0.93] | 1.69** | [1.15 | 2.50] |
Desired labor companion | 1.42* | [1.01 | 2.00] | |||
Desired delivery companion | 1.97*** | [1.48 | 2.62] | |||
Interviews in community (ref = HF) | 1.02 | [0.70 | 1.49] | 0.79 | [0.54 | 1.14] |
Postpartum length= > 1 week (ref < 1 | 0.99 | [0.53 | 1.83] | 1.24 | [0.64 | 2.38] |
Constant | 0.87 | [0.22 | 3.42] | 0.15* | [0.033 | 0.64] |
N | 763 | 764 |
Women’s perspectives on labor and delivery support: Qualitative data from FGDs with women
Feelings about being allowed or denied a companion during labor and delivery
“They allowed the relatives to be with us ….I felt good because there are times you can be going to bath, and so they will remain and take care of the baby for you.” (KP5)“No they didn’t [allow relative to stay] and I did not like it because they are busy with their own things and it is this relative of yours who can help you with your problem…” (WP1)
“I wanted her to be with me so that I can explain to her how am feeling so that in case I need help then I send her to go and call the doctor or nurse to come and help me quickly and they kept on telling them that “get out care takers your time is not now, wait until they give birth is when you can come in”, and yet after giving birth am not as serious as when I still have my labor pains when am not supposed to be alone and so I felt bad.” (WP2)
“I felt it was good if they were allowed to be with me after having my baby. But before, it was good that they were not allowed to be with me.” (CP10)
“They refused and even chased the person who accompanied me and told her ‘leave her alone …. you did not give her the pregnancy she will deliver it herself’…. that was not good.” (MP2)
“They refused so I just stayed alone in the hospital until I stayed two days in the hospital… It is required that I just stay alone…. I felt bad” (MP4)“They do not always allow somebody to be with you, it is the doctor and you alone. Whoever has brought you is to wait outside” (OP5)“They do not want someone to be close to you, even after giving birth, they tell them that time for visiting patients is over and they send them away.” (CP10)
“I was allowed to be with a woman relative but not a man… The woman relative was allowed for when there is a problem she can assist the nurse, but a male relative they do not allow them to stay.” (P10)
Reasons for desiring a companion
“They did not allow them just as the other person has said, you want to be with your relative and they are sent out. You know sometimes they the doctors are out and have gone wherever places. For you your labor is bad and you are bleeding, so the energy that you will have to walk and go to call the doctor you do not have and so it is your relative whom you can send to go and get you the doctor and so that is why I was not happy with this.” (WP6)
“I feel it is good to have someone with you because sister [the nurse] can show you the bed to go and sleep, then she goes to sit somewhere else. So if you are about to give birth then you can send her to go and call for you the nurse so that she can come and help you.” (CP4)
“ I feel that they should be next to you because, the doctor can tell you that there is some drug that you should be treated with, and so he can be sent to go to the chemist to go and buy.” (CP1)“They should be around because sometimes you can develop complications and you are being referred and so if you are alone then you may not be able to get help.” (OP6)
“They should be allowed. Because they can help you with carrying the baby.” (CP10)
“I felt good because there are times you can be going to bath, and so they will remain and take care of the baby for you.” (KP5)
“They should allow your relatives to be with you at that particular time in case that anything happens then they can share with the nurses to know what next is to be done to you, because at that time, you are in so much pain that you cannot make any wise decision.” (KP3)
“For me I like it because at that time I do not know anything that am doing so when she is there then she will be able to tell me that at that time you did this and that until the doctor either did this to you is when you were able to put to birth.” (OP3)
“That was not good because when you have someone near, she will try to make your heart relax, yes, but when they refuse you are just alone you will surely have some problems.” (MP2)
Reasons for not desiring for a companion
“I do not want because when you left home…they could not help you and so that is why you came to get help from the hospital.” (CP4)
“I feel that it is the right thing [that companion was asked to wait outside] because whoever has brought you is not the doctor, and he has brought you in safe hands of the doctor and so he should just stay out and wait …. because there is nothing he will do apart from just looking at you and so it is only when the doctor is not able then he will refer you.” (OP4)
“It is the doctor who knows everything and so he is the one who should be with you alone in the delivery room but the other person I would not like him to be next to me when I am giving birth.” (OP3)
“ I should be with the doctor alone because she is the one with all the know-how but this relative of mine, all he will do is just look and laugh at you.” (WP2)
“We did not say that it is bad to have someone with you…let them just come. But when time comes that you are in a state of between you and your God, then let them stay outside and wait for you….At that time, he should not see my nakedness.” (OP3)
“No, I feel embarrassed and [will] rather be with the doctor alone in that hospital.” (CP5)“I refused because when you are giving birth, maybe you do not have clothes and you are with your mother-in-law so you feel embarrassed.” (CP8)“It is better if you are with the nurse alone because for her she has seen a lot but the other person can exclaim that ‘ei and this person.” (CP10)
“I did not like it because whoever escorted me is the one that the doctor made to carry for him the sport light and was pointing it at me and I did not like it at all….but it is only that I was in a problem and I was praying to God to help me, but my inner heart did not like the fact that this person was seeing my nakedness.” (OP3)
“At that time they should not allow someone to be in, the doctor is the only person who should see my nakedness…people are so mouthy. Some people when they leave the hospital they go and say so many strange things about you, how they saw you, but the doctor is not allowed to go out and talk about what has happened in the facility.” (KP4)“For me I don’t want because they can look at you then go and tell other women that ei.. so and so is like this.” (CP2)“For me I liked it and felt good [that the person was not allowed inside] because whoever is taking care of you can go out and talk about your secret but the doctor cannot.” (CP5)
“After reaching with her at the door, then he should stay aside because you are very angry at that time and so you can find yourself insulting her.” (CP10)
“it’s good to be with a parent when giving birth, like me I was with my mother when I was giving birth and I was attended to well but when you are with your mother in law, when taking care of you, she will shout at you that stop disturbing me but when you are with your mother then she will take good care of you, it’s good to be with your mother than any other person.” (CP9)
Reasons for not desiring birth companionship from their partner
“ He will not help you with anything…so it is better for him to be away.” (KP2)
“ While I was giving birth, I went with my husband as my mum lives in [another town]. But my husband was waiting for me far away…. I really did hate him at that time (…Laughs…) when that time came I felt hatred for him and I told him you sit that side” (CP6)
“When I am inside, I would want him just to stay outside there…The time the baby is coming out, is not a good sight for a man to be there…They always say that when a woman is delivering and the time the baby is coming out, your body is not looking good so when the husband sees that, after delivery, he will not have a desire (sexual desire) for you. That is what is said and most of us mothers know about this {laughter…}. They prevent the husbands from seeing this so that later he may have a desire for you. That is why the nurse will enter inside with you only unless there is something she cannot handle is when he will be allowed in (WP4). M: This is what nurses are saying or who?{All in chorus, nurses…}”
My third child I delivered at the TBA place. I was accompanied by my husband and other mother-in-laws. When we arrived there the baby was almost coming out, he was told to stay outside [and] not to go in. This was because the Luo culture says that when your husband goes inside with you where you are going to deliver, he will tie you and the baby might delay in coming out, so it is not good that we go with our husbands to where we are delivering (WP7).
“For me in most occasions when am going to deliver, I usually go with my husband, and when we go when we reach, after I have been admitted, Like this one, they asked me whoever he was to me and I told them that he is my husband and they asked me if I wanted him to stay behind and be with me. But I told them that no the children are home alone and so he must go back home as I was in safe hands and he was to go back and only call him in case there is anything that needs his attention then they could call him come back…I did not see the point of having [him] around because when giving birth, even if he is my own husband I do not want him to be with me at that time, I want only a doctor.” (KP2)
Providers’ perspectives: quantitative and qualitative data from in-depth-interviews with providers
Characteristics of Providers | Percent reporting women are allowed continuous support during | |||||
---|---|---|---|---|---|---|
Labor | Delivery | |||||
No. | % | No. | % | No. | % | |
Facility type | ||||||
Govt. Hospital | 30 | 61.2 | 22 | 73.3 | 10 | 33.3 |
Govt. Health Center | 13 | 26.5 | 13 | 100 | 6 | 46.2 |
Mission Hospital | 6 | 12 | 6 | 100 | 3 | 50 |
Position in facility | ||||||
Clinical officer | 7 | 14.3 | 7 | 100 | 4 | 57.1* |
Nurse/Midwife | 25 | 51 | 19 | 76 | 12 | 48 |
Support staff | 17 | 34.7 | 15 | 88.2 | 3 | 17.6 |
Gender | ||||||
Male | 14 | 28.6 | 14 | 100 | 9 | 64.3* |
Female | 35 | 71.4 | 27 | 77.1 | 10 | 28.6 |
Age | ||||||
24 to 39 years | 30 | 61.2 | 26 | 86.7 | 12 | 40 |
40 to 58 years | 19 | 38.8 | 15 | 78.9 | 7 | 36.8 |
Marital status | ||||||
Single/Widowed | 8 | 17 | 7 | 87.5 | 3 | 37.5 |
Married | 39 | 83 | 32 | 82 | 15 | 38.5 |
Parity | ||||||
0 to 3 | 34 | 72.34 | 28 | 82.4 | 13 | 38.2 |
4 to 7 | 13 | 27.66 | 11 | 84.6 | 5 | 38.5 |
Feels Facility is crowded | ||||||
No, never | 14 | 28.6 | 12 | 85.7 | 5 | 35.7 |
Yes, a few times | 6 | 12.2 | 5 | 83.3 | 3 | 50 |
Yes, most of the time | 23 | 46.9 | 21 | 91.3 | 9 | 39.1 |
Yes, all the time | 6 | 12.2 | 3 | 50 | 2 | 33.3 |
Women allowed labor support | ||||||
No, never | 1 | 2 | ||||
Yes, a few times | 6 | 12.2 | ||||
Yes, most of the time | 12 | 24.5 | ||||
Yes, all the time | 29 | 59.2 | ||||
Women allowed delivery support | ||||||
No, never | 18 | 36.7 | ||||
Yes, a few times | 12 | 24.5 | ||||
Yes, most of the time | 9 | 18.4 | ||||
Yes, all the time | 10 | 20.4 | ||||
Total | 49 | 100 | 41 | 83.7 | 19 | 38.8 |
Role birth companions play in the facility
“You know after that like now we have staff shortage, so maybe after examining a mother maybe I am alone in the facility, I may run to come and see clients here but when they are almost ready, she will come and call me. Even after delivery helping them to do one, two, three, like cleaning the clothes something like that.”
“Most of the time we need one caretaker to be around. In case of any eventuality they can be asked to go may be to organize for example in a case of complicated delivery and you want things like gloves somebody at least you can send to get for you the things you want, so most of the times we allow one caretaker to be around the mother who is giving birth.”
“Rarely do we not allow birth companions, rarely, not unless the mother came alone. There are some who come without Birth companions though during ANC they are encouraged to have with Birth partners, but when they come without they are equally just served as others. But when they come with a birth partner, especially X facility, if they do not assist us I don’t know how we would do it, because they do assist us even wheeling the patient to the bedside post delivery they do a lot to us especially to me when I am on duty, they do a lot.”“We have no problem, if the mother has allowed someone who escorted her to labor to get in then we have no problem with the person as there was a time when a mother was delivering and it is the husband who was holding for us the touch.”
“The delivery room is small so the nurse will only need the person who will assist her get things like cotton wool, bucket for the placenta and water.”
“The relative may only come in when it is at night and the lights are off so the care taker gets in to hold for the nurse the torch only.”
“This time is more private, he does not allow anyone to be with the mother unless he is alone and the mother is not cooperative…[that] is when he will call a relative to come and talk to the mother to push the baby.”“No, it is only the nurses who are in there. The person is to wait outside. Only if the woman is difficult to deal with is when they call the caretaker to come in and help them.”
Reasons why companions may not be allowed in the ward
If they are two in labor then now you see the privacy will [be a problem] …but if that woman is all alone there, then we will just allow, so it is more of the setup which is preventing us but we know…that if they want even their spouses to come to the delivery room they should be allowed but because of the setup and the environment now it is not really conducive.
“Yes, we allow them but it is not a normal practice here and at second stage we do not allow them. Here you find maybe they came with them, they stay with them but when we are going to second stage we tell them to wait until the time they have delivered. But that one is done because of space as I was saying. Maybe…the relative of this mother A is there and another mother B is delivering so when I bring these relatives here they will also be watching this mother B, so we say let me counsel them when we need them we can always call them after delivery”
“like here they like coming with the herbs, since the nurse is one, you leave the mother with the care taker and by the time you are back, you find that they have place for the mother the herb, so it depends on who has brought the client.”
“Sometimes you find the mother in second stage, a mother comes in, there are certain things they usually practice home deliveries, so you can find that they start practicing that so we don’t allow that in health care so this is why. Mothers at home give fundal [pressure] and they can touch anywhere with bare hands, yeah so in a normal delivery procedure they remain outside the delivery room.”
“Mostly those old mothers, the grannies, the mother in laws who are old. They believe that once a mother comes to the labor ward to deliver, maybe to get a baby as fast as possible, so once they are around, they can discuss and give the mother some medicine to fasten delivery so [because of] that most of us who are midwives are very keen and we don’t want those mothers to come so many of them, they can give herbal medicine or they boil tea concentrated without sugar as they believe that this one will hasten the delivery. That act most of us are not ready to entertain.”
“some mothers come with the herbs and force the laboring woman to drink or chew and so that is why we don’t usually allow them to come in where the woman is”
“Mmm sometimes you get, okay personally, the mothers who come with a companion, give misinformation to the mothers, they force the mothers to push before they are fully dilated, and that is why many a times I do not allow them because they give a lot of misinformation to the mothers while they are in labor. [It causes] those things like cervical tear which are not supposed to be there.”
“When you have invasive procedure… the companion is not supposed to be around to see, for they can feel that you did that thing wrongly and yet we were helping the mother or the baby. I: Like what procedures? R1: Like vacuum extraction you cannot allow the companion to be there. There is fear they can take the information at home that they did this that killed our baby by using the instruments.”
Some women after seeing the woman delivering, they go and talk about how the woman’s private part is. Some women also give birth to babies who are white with a lot of whitish things in them, so they go and start gossiping how the woman was having sex until the last minute is why the baby is born dirty. So that is why the nurses want to do everything and clean the baby. [That] is when she is taken to the other room for the relatives and friends to see the baby.
“…some care takers are so stubborn they talk to the nurses as if they know everything that the nurse should be doing.”
“Sometimes, some people want to be the nurse and so they give the nurse orders in there. So such people are told to wait in the labor room.”
“…also it depends on the understanding as some of them will come and don’t want to listen to the instructions of the provider.”
“Like when the patient is positive (HIV) the doctor will first talk to her and find out from the patient whom to inform and not everybody because at times is a neighbor who brought her. Also find out from her who will collect the drugs for her. In such a case is only the doctor who will be with the patient until she says whom she would want to be closer to her.”
“Okay, sometimes if a woman has a chronic condition that you need to monitor, so we may not like a lot of relatives to be there but we have to inform the relative that we are doing this and this. So you will find at that time [only] the health worker will be so near to the patient to monitor.”
“Sometimes just in case of any complication as those people, the family people, they will tend to change to discourage the patient by the way they behave. Like they are so anxious about the patient and they try to discourage.”“Some relatives are so scared and so they are not allowed to get in because they will make the woman to also be scared.”
“There are a few cases the condition of a mother does not warrant the relatives to be near the mother because of big number like sometimes we had seen somebody who has escorted the patient after seeing the thing fainted, now you will have double work, you are struggling with the mother and somebody has just fainted. So in such scenarios in some cases we do tell some not to. Or you are seriously resuscitating a child and the person who has escorted the mother is crying, you tell her to be out as we do the resuscitation process.”
Respecting the woman and companions wishes
“ If the mother who is in labor says, me I do not want anyone around until I deliver. [1] just preserve that as her right, but most of the times we just allow the relatives to be around.”
R: During labor pains, most of the women become very cruel or very rude. So some of the family members may be afraid to go and be with them in there. [Laughs]We tell her to choose the best person so if she does not want you then we tell you to leave.
Perceptions about partners as birth companions
“ Mostly we allow the husband, we allow them to be with the wife but if another care taker, sometimes we don’t allow. I: Why, what is the reason? R1: Because you never know who is the caretaker”
“we do not know the caretaker and you know family issues we don’t interfere, only the husband we allow in the delivery room if the patient is willing, some patients are not willing; they tell the husband go away”
“Maybe the mother will just say let him [partner] or her go outside for sometime. They do not like when they are pushing especially their husbands [to be around].”“Sometimes it is the husband who has come, and the woman is the one who sends him away so we also tell them to keep off and wait outside as she is putting to birth”
“They are allowed, but men mostly don’t come…One said that he didn’t want to see the lady naked, he doesn’t want to see her being handled during delivery. But us we do allow them”
“I may say its culture, let me say if it’s a husband who has brought the wife, some of them do not want to go where the woman is laboring.”
“when the husband is around this might affect her psychologically as when she sees the husband she might want the sympathy from him. When the husband is away she will be with the nurses who should take care of her.”