Understanding Women’s Choices: How Women’s Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya. A Qualitative Study

  • Maternal and Child Health Journal, Volume 25, No. 11, Year 2021

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Study Justification:
– Maternal mortality rates in Kenya are still unacceptably high.
– The introduction of a free maternity service by the Kenyan Government has increased women’s delivery options.
– However, there is concern that the increase in coverage may have led to a reduction in the quality of care.
– This study aims to explore women’s perceptions of the quality of delivery services in the context of the free policy and how these perceptions influence their choice of a place for delivery.
Study Highlights:
– The study was conducted in Naivasha sub-County, Kenya, which is a rural area with diverse demographics.
– The participants were women of reproductive age attending antenatal care clinics at six health facilities in the sub-county.
– Qualitative methods, including focus group discussions, were used to gather data.
– Four broad themes were identified as factors influencing the choice of health facility for delivery: women’s perceptions of clinical quality of care, the cost of delivery, distance to the health facility, and management of primary health facilities.
– An unexpected theme was the presence of home deliveries among pastoralist women.
– The findings suggest that both the process and structural dimensions of quality of care, as well as financial and physical accessibility, influence women’s choices for the place of delivery.
Recommendations for Lay Reader and Policy Maker:
– Policy makers should prioritize improving the quality of care in maternity services to ensure that the increased utilization of services under the free maternity policy does not compromise patient outcomes.
– Facility managers should focus on providing patient-centered maternity care that addresses women’s perceptions of quality and ensures a positive birthing experience.
– Efforts should be made to address the financial and physical barriers to accessing quality maternity care, particularly for women from low-income backgrounds and those living in remote areas.
– Strategies should be developed to address the presence of home deliveries among pastoralist women, including improving the availability and accessibility of health facilities in their communities.
Key Role Players:
– Policy makers and government officials responsible for healthcare policy and funding.
– Facility managers and administrators of health facilities providing maternity services.
– Healthcare providers, including doctors, nurses, and midwives, involved in delivering maternity care.
– Community leaders and organizations working to improve maternal health in rural areas.
– Researchers and academics studying maternal health and healthcare delivery.
Cost Items for Planning Recommendations:
– Infrastructure development and improvement of health facilities, including equipment and supplies.
– Training and capacity building for healthcare providers to ensure the delivery of high-quality maternity care.
– Outreach programs and community engagement initiatives to improve awareness and access to maternity services.
– Monitoring and evaluation systems to assess the quality of care and track progress in reducing maternal mortality.
– Research and data collection to inform evidence-based decision making and policy development.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study conducted in a specific rural sub-county in Kenya. The study used focus group discussions with 55 respondents to explore women’s perceptions of quality of care and their choices for place of delivery. The findings identified four broad themes that influenced the choice of health facility for delivery. While the study provides valuable insights into women’s decision-making process, the evidence is limited to a specific context and may not be generalizable to other settings. To improve the strength of the evidence, future research could include a larger sample size and a more diverse population to enhance the external validity of the findings.

Background: Maternal mortality is still unacceptably high in Kenya. The Kenyan Government introduced a free maternity service to overcome financial barriers to access. This policy led to a substantial increase in women’s delivery options. This increase in coverage might have led to a reduction in quality of care. This study explores women’s perceptions of quality of delivery services in the context of the free policy and how the perceptions lead to the choice of a place for delivery. Methods: Our study site was Naivasha sub-County in Kenya, a rural context, whose geography encompasses pastoralists, rural agrarian, and high population density informal settlements near flower farms. Women from this area are from the lowest wealth quintile in Kenya. We conducted a qualitative study to explore the women’s perceptions of quality of care based on their experiences during maternity care. The participants were women of reproductive age (18–49 years) attending antenatal care clinics at six health facilities in the sub-county. Six focus group discussions with 55 respondents were used. For inclusion, the women needed to have delivered a baby within the six months preceding the study. Interviews were recorded with consent, translated and transcribed. The interviews were analyzed using a thematic content approach. Results: Four broad themes that determined the choice of health facility for delivery were identified: women’s perceptions of clinical quality of care; the cost of delivery; distance to the health facility and management of primary health facilities. An unexpected theme was the presence of home deliveries amongst pastoralist women. These findings suggest that in this setting both process and structural dimensions of quality of care and financial and physical accessibility influence women’s choices for place of delivery. Conclusion: This study expands our understanding of how women make choices regarding place of delivery. Understanding women’s perceptions can provide useful insights to policy makers and facility managers on providing high quality patient centered maternity care necessary to sustain the increased utilization of maternity services at health facilities under the free maternity policy and further reductions in maternal mortality.

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The study “Understanding Women’s Choices: How Women’s Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya” provides several recommendations to improve access to maternal health. These recommendations can be developed into innovations as follows:

1. Enhancing the quality of care: Develop a training program for healthcare providers that focuses on patient-centered care. This program should aim to improve their skills and knowledge in providing high-quality maternity services. Additionally, ensure the availability of necessary medical equipment and supplies to enhance the quality of care provided.

2. Addressing financial barriers: Allocate sufficient funds to ensure the sustainability of the free maternity service introduced by the Kenyan Government. This can involve budgeting for additional staff, resources, and infrastructure improvements to maintain high-quality care despite the increase in coverage.

3. Improving physical accessibility: Implement innovative solutions such as mobile health clinics or outreach programs to bring maternal health services closer to rural and remote areas. This can help overcome geographical barriers and ensure that women have access to timely and appropriate care.

4. Empowering women through education: Develop educational programs that empower women with knowledge about their rights, available healthcare options, and the importance of seeking skilled care during pregnancy and childbirth. This can help women make informed decisions and advocate for their own healthcare needs.

By implementing these innovations, policymakers and healthcare providers can work towards improving access to maternal health services, enhancing the quality of care, and ultimately reducing maternal mortality rates in Kenya.
AI Innovations Description
Based on the study “Understanding Women’s Choices: How Women’s Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Enhancing the quality of care: Based on the findings of the study, it is crucial to focus on improving the quality of care provided during maternity services. This can be achieved by implementing training programs for healthcare providers to enhance their skills and knowledge in providing patient-centered care. Additionally, ensuring the availability of necessary medical equipment and supplies can contribute to improving the quality of care.

2. Addressing financial barriers: While the Kenyan Government introduced a free maternity service to overcome financial barriers, the study suggests that the increase in coverage might have led to a reduction in quality of care. To address this issue, it is important to allocate sufficient funds to ensure that the free maternity service is sustainable and can provide high-quality care. This may involve budgeting for additional staff, resources, and infrastructure improvements.

3. Improving physical accessibility: The study highlights the influence of distance to health facilities on women’s choices for the place of delivery. To improve access, innovative solutions such as mobile health clinics or outreach programs can be implemented to bring maternal health services closer to rural and remote areas. This can help overcome geographical barriers and ensure that women have access to timely and appropriate care.

4. Empowering women through education: The study identifies women’s perceptions of quality of care as a key factor influencing their choice of delivery place. To address this, educational programs can be developed to empower women with knowledge about their rights, available healthcare options, and the importance of seeking skilled care during pregnancy and childbirth. This can help women make informed decisions and advocate for their own healthcare needs.

By implementing these recommendations, policymakers and healthcare providers can work towards improving access to maternal health services, enhancing the quality of care, and ultimately reducing maternal mortality rates in Kenya.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a mixed-methods approach can be used. Here is a brief description of the methodology:

1. Quantitative Data Collection: Conduct a survey or collect existing data to gather quantitative information on key indicators related to maternal health access, such as the number of deliveries at health facilities, maternal mortality rates, distance to health facilities, and women’s perceptions of quality of care. This data will serve as a baseline for comparison before and after implementing the recommendations.

2. Qualitative Data Collection: Conduct interviews or focus group discussions with women of reproductive age who have recently delivered a baby to gather qualitative insights on their perceptions of quality of care, financial barriers, and physical accessibility. This will provide a deeper understanding of the factors influencing women’s choices for the place of delivery.

3. Intervention Implementation: Implement the recommendations outlined in the abstract, such as enhancing the quality of care, addressing financial barriers, improving physical accessibility, and empowering women through education. This may involve training healthcare providers, allocating funds for free maternity services, implementing mobile health clinics or outreach programs, and developing educational programs for women.

4. Post-Intervention Data Collection: Repeat the quantitative data collection and qualitative interviews/focus group discussions after the implementation of the recommendations. This will allow for a comparison of the indicators and insights gathered before and after the intervention.

5. Data Analysis: Analyze the quantitative data using statistical methods to assess changes in key indicators, such as an increase in deliveries at health facilities or a decrease in maternal mortality rates. Analyze the qualitative data using thematic analysis to identify any changes in women’s perceptions of quality of care, financial barriers, and physical accessibility.

6. Evaluation and Reporting: Evaluate the impact of the recommendations based on the findings from the data analysis. Prepare a report summarizing the changes observed in access to maternal health services and the factors influencing women’s choices for the place of delivery. This report can be used to inform policymakers, healthcare providers, and other stakeholders about the effectiveness of the recommendations and guide future interventions.

By following this methodology, researchers can assess the impact of the recommendations on improving access to maternal health and gain valuable insights to inform policy and practice in Kenya.


Identifiers:
DOI: 10.1007/s10995-021-03214-3
ISSN: 10927875
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health
Study Countries:
Kenya
Study Design:
Cross Sectional Study
Study Approach:
Qualitative
Participants Gender:
Female
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