Determinants of maternity care utilization in Kenya.

This study examines use of formal birth attendants by women of reproductive age in Kenya. Forty-five percent of these women used this type of maternity care services. Because of the important role played by modern health care in mortality reduction in developing countries, the question of interest in this study is whether a woman's predisposing, enabling, and health risk factors determine delivery care utilization. The study uses data from the 1993 Kenya Demographic and Health Survey to answer this question. Analysis is restricted to the most recent live births among women who gave birth during the five years preceding the survey. Using the logistic regression method of statistical analysis, this study reveals some interesting findings. First, in analyzing the predisposing factors, younger maternal age and lack of formal education have a significant negative effect on the use of delivery care services. Parity is a significant determinant of maternity care utilization. Primiparous women are significantly more likely to use maternity care services compared to multiparous women. Husband's education is also an important determinant of use of delivery care services. Women who have had contact with the health care system, (for example, attending prenatal care and ever use of contraceptives), are more likely to use delivery care services than those who have not. Women from the Kamba, Luo, Luhya, and Mijikenda ethnic groups are significantly less likely to use delivery care services. Second, enabling factors such as distance, residence, and province of origin, are significant determinants of using delivery care services. The study found that as distance to the nearest health facility increased, use decreased substantially. Women residing in the urban areas were more likely to use delivery care services compared to their rural counterparts. Women from Coast and Western provinces were significantly less likely to use delivery care services. Finally, in examining the health risk factors, the study found that women who had experienced death of an infant were significantly less likely to use delivery care services compared to those who had not. Longer birth intervals and higher body mass index was also related to use of delivery care services. In light of the fact that over fifty percent of Kenyan women in the reproductive age are not using delivery care services, this study suggests the following recommendations: (1) Targeting women from those ethnic groups that are not using services through information, education, and communication (IEC) activities and provision of services. (2) Since 95% of the women used some prenatal care services, these visits should be used as an opportunity to educate women of the importance of delivery care use, coupled with expansion of family planning education and services. Due to the gap between use of prenatal care services and use of maternity care services, there is need to re-examine prenatal care services with regard to their content and objectives. (3) Since education is an important determinant of delivery care use, the study recommends continued investment in the education of the female child and to enact policies that allow girls who drop out of school due to pregnancy to continue with their education after delivery.Ph.D.Health and Environmental SciencesObstetricsPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132048/2/9939777.pd