Bypassing high-quality maternity facilities: Evidence from pregnant women in peri-urban Nairobi

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Study Justification:
– The utilization of high-quality maternal care is crucial for improving maternal health outcomes.
– Despite the availability of high-quality facilities, women in peri-urban Nairobi do not always deliver in these facilities.
– This study aims to understand why women bypass their nearest high-quality facilities and choose to deliver in facilities with lower technical quality.
Highlights:
– The study collected survey data from 358 pregnant women and conducted facility assessments on 59 facilities.
– Women who bypassed their nearest high-quality facility were compared to those who delivered in their nearest facility.
– Among the bypassers, 65.5% delivered in non-CEmONC facilities with lower technical quality, while 34.5% delivered in farther CEmONCs with higher technical quality.
– Bypassers rated their delivery experience higher than non-bypassers.
– Bypassers who delivered in non-CEmONCs were less likely to have completed four antenatal care visits and consider delivering in any CEmONC prior to delivery.
– Bypassers who delivered in farther CEmONCs paid more for delivery and were more likely to report being able to access emergency funds.
Recommendations:
– Policies should focus on improving women’s delivery experience to encourage utilization of high-quality maternity facilities.
– Widely distributing information about facility technical quality can help women make informed decisions about where to deliver.
Key Role Players:
– Ministry of Health
– Local government authorities
– Maternity facility administrators
– Community health workers
– Non-governmental organizations (NGOs) working in maternal health
Cost Items for Planning Recommendations:
– Public awareness campaigns
– Training programs for healthcare providers
– Facility upgrades and maintenance
– Information dissemination materials (brochures, posters, etc.)
– Monitoring and evaluation activities

Utilization of high-quality maternal care is an important link along the pathway from increased facility-based delivery to improved maternal health outcomes, however women in Nairobi do not all deliver in the highest quality facilities available to them. We explored whether women living in peri-urban Nairobi who live nearby to high-quality facilities bypassed, or travelled farther than, their nearest high technical quality facility using survey data collected before and after delivery from women (n = 358) and from facility assessments (n = 59). We defined the nearest high technical quality facility as the nearest Comprehensive Emergency Obstetric and Newborn Care (CEmONC) capable facility to each woman’s neighbourhood. We compared women who delivered in their nearest CEmONC (n = 44) to women who bypassed their nearest CEmONC to deliver in a facility that was farther away (n = 200). Among bypassers, 131 (65.5%) women delivered in farther non-CEmONC facilities with lower technical quality and 69 (34.5%) delivered in farther CEmONCs with higher technical quality capacity compared to their nearby CEmONCs. Bypassers rated their delivery experience higher than non-bypassers. Women who bypassed to deliver in non-CEmONCs were less likely to have completed four antenatal care visits and to consider delivering in any CEmONC prior to delivery while women who bypassed to deliver in farther CEmONCs paid more for delivery and were more likely to report being able to access emergency funds compared to non-bypassers. Our findings suggest that women in peri-urban Nairobi bypassed their nearest CEmONC facilities in favour of delivering in facilities that provided better non-technical quality care. Bypassers with access to financial resources were also able to deliver in facilities with higher technical quality care. Policies that improve women’s delivery experience and ensure that information about facility technical quality is widely distributed may be critical to increase the utilization of high-quality maternity facilities.

The study “Bypassing high-quality maternity facilities: Evidence from pregnant women in peri-urban Nairobi” recommends implementing policies to improve access to maternal health. These recommendations include:

1. Enhancing women’s delivery experience: This involves providing respectful and supportive care, addressing women’s preferences and needs, and promoting a positive birthing environment. Training healthcare providers on respectful maternity care and implementing guidelines for quality maternal care can help achieve this.

2. Widely distributing information about facility technical quality: Making information about facility technical quality easily accessible and understandable can help women make informed decisions about where to deliver. This can be done through the development and dissemination of facility ratings or rankings based on technical quality indicators. Information can be shared through community outreach programs, mobile applications, and online platforms.

3. Addressing financial barriers: Financial constraints can prevent women from accessing high-quality maternity facilities. Providing financial support or implementing health insurance schemes that cover the cost of delivery in high-quality facilities can help overcome this barrier.

These recommendations aim to improve access to maternal health by focusing on improving women’s delivery experience, increasing awareness of facility technical quality, and addressing financial barriers.
AI Innovations Description
The recommendation to improve access to maternal health based on the study “Bypassing high-quality maternity facilities: Evidence from pregnant women in peri-urban Nairobi” is to implement policies that focus on improving women’s delivery experience and ensuring that information about facility technical quality is widely distributed.

By enhancing women’s delivery experience, such as providing respectful and supportive care, addressing their preferences and needs, and promoting a positive birthing environment, it can encourage more women to utilize high-quality maternity facilities. This can be achieved through training healthcare providers on respectful maternity care and implementing guidelines for quality maternal care.

Additionally, ensuring that information about facility technical quality is widely available can help women make informed decisions about where to deliver. This can be done through the development and dissemination of easily accessible and understandable information, such as facility ratings or rankings based on technical quality indicators. This information can be shared through various channels, including community outreach programs, mobile applications, and online platforms.

Furthermore, efforts should be made to address barriers that prevent women from accessing high-quality maternity facilities, such as financial constraints. Providing financial support or implementing health insurance schemes that cover the cost of delivery in high-quality facilities can help overcome this barrier and enable more women to access the care they need.

Overall, a multi-faceted approach that focuses on improving women’s delivery experience, increasing awareness of facility technical quality, and addressing financial barriers can contribute to improving access to maternal health and increasing the utilization of high-quality maternity facilities.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be employed:

1. Data Collection: Collect data on women’s delivery experiences, including their preferences, needs, and satisfaction levels. This can be done through surveys conducted before and after delivery, similar to the study mentioned in the abstract. Additionally, gather information on facility technical quality indicators and ratings.

2. Sample Selection: Select a representative sample of pregnant women living in peri-urban areas of Nairobi who have access to high-quality maternity facilities. Ensure that the sample includes both women who delivered in their nearest high-quality facility and those who bypassed and delivered in facilities farther away.

3. Intervention Implementation: Implement policies aimed at improving women’s delivery experience and ensuring the wide distribution of information about facility technical quality. This can include training healthcare providers on respectful maternity care, implementing guidelines for quality maternal care, and developing easily accessible and understandable information about facility technical quality.

4. Data Analysis: Analyze the collected data to assess the impact of the interventions on access to maternal health. Compare the outcomes between women who received the interventions and those who did not. Key indicators to consider include the proportion of women utilizing high-quality maternity facilities, changes in women’s delivery experience and satisfaction levels, and changes in awareness and knowledge about facility technical quality.

5. Statistical Modeling: Use statistical modeling techniques, such as regression analysis, to quantify the impact of the interventions on access to maternal health. This can help identify the specific factors that contribute to improved access, such as the effect of respectful maternity care on women’s decision to utilize high-quality facilities.

6. Cost-Benefit Analysis: Conduct a cost-benefit analysis to evaluate the economic implications of implementing the recommended policies. Assess the cost-effectiveness of the interventions and determine the potential return on investment in terms of improved maternal health outcomes.

7. Policy Recommendations: Based on the findings of the simulation, provide clear policy recommendations on how to effectively improve access to maternal health. These recommendations should consider the identified factors that influence women’s decision-making and address any barriers that prevent women from utilizing high-quality maternity facilities.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of implementing the recommended interventions and make informed decisions on strategies to improve access to maternal health.

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