The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities

Gitobu, C.M.; Gichangi, Peter; Mwanda, Walter

doi:10.1186/s12884-018-1708-2

Cited by 102 publications

(96 citation statements)

References 19 publications

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“…Second, 16 Focus Group Discussions (FGDs), 8 in each county, were facilitated to include a broad representation of community members and community health committee members. FGDs were stratified to include 2 each for adult males; adult females aged 20-49, and adolescent females ages [16][17][18][19]. The separate adolescent female FGDs were conducted to ensure that the specific experiences among female adolescents were captured.…”

Section: Study Sample Participantsmentioning

confidence: 99%

“…In Kenya, under the Free Maternity Policy (FMP) established in 2013, an increasing number of women have elected to give birth in maternity care facilities rather than at home with traditional birth attendants (TBA) [18,19] [18,19]. Despite these gains, infant mortality and morbidity rates in Kenya remain stubbornly high and not all pregnant women may be willing to attend facility care services.…”

Section: Introductionmentioning

confidence: 99%

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Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

et al. 2020

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BackgroundUnder the Free Maternity Policy (FMP), Kenya has witnessed an increase in health facility deliveries rather than home deliveries with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal outcomes. Despite these gains, maternal and infant mortality and morbidity rates in Kenya remain unacceptably high indicating that more needs to be done. AimUsing data from the Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project's qualitative gender assessment, this paper examines women's experience of disrespectful care during pregnancy, labour, and delivery. The goal is to promote an improved understanding of the actual care conditions to inform the development of interventions that can lift the standard of care, increase maternity facility use, and improve health outcomes for both women and newborns. MethodologyWe conducted sixteen focus group discussions (FGDs), two each for adolescent females, adult females, adult males, and community health committee members. As well, twenty-four key Informants interviews (KII) were also conducted including religious leaders, and persons from local government representatives, Ministry of Health (MOH), and local women's organizations. Data were captured through audio recordings and reflective field notes. Research siteKisii and Kilifi Counties in Kenya. PLOS ONE | https://doi.org/10.1371/journal.pone. Data Availability Statement:Data from this study are available upon request. This is due to ethical reasons. The study involved 24 key informant interviews (KIIs) and 16 focus group discussions with female adolescents, women, men, and members of community health committees. The KIIs were held (12 at each site) with two health service providers, two community health care workers, two local religious leaders, two local government representatives, two Ministry of Health representatives, and two representatives of local women's organizations. It is possible for someone from the study sites to deduce whom the Findings Findings show nursing and medical care during labour and delivery were at times disrespectful, humiliating, uncompassionate, neglectful, or abusive. In both counties, male health workers were preferred by women giving birth, as they were perceived as more friendly and sensitive. Adolescent females were more likely to report abuse during maternity care while women with disabled children reported being stigmatized. Structural barriers related to transportation and available resources at facilities associated with disrespectful care were identified.

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Section: Study Sample Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

et al. 2020

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“…At the time, 56% of Kenyan women still delivered at home alone or with the assistance of Traditional Birth Attendants (TBAs) and relatives, contributing to the persistently high national maternal mortality ratio (488 maternal deaths per 100,000 live births) [3]. The maternity care policy and political drive around eliminating maternal and neonatal deaths, exemplified by the First Lady's Beyond Zero Campaign, have contributed to an increase in facility-based deliveries [10,11]. Despite this increase, more than a third of births (37%) of deliveries in Kenya continue to occur at home, where SBA supervision is unlikely to occur [4], and no significant decrease in maternal or neonatal deaths has yet been observed [10].…”

Section: Introductionmentioning

confidence: 99%

“…The maternity care policy and political drive around eliminating maternal and neonatal deaths, exemplified by the First Lady's Beyond Zero Campaign, have contributed to an increase in facility-based deliveries [10,11]. Despite this increase, more than a third of births (37%) of deliveries in Kenya continue to occur at home, where SBA supervision is unlikely to occur [4], and no significant decrease in maternal or neonatal deaths has yet been observed [10]. In many low-income settings, home birth without an SBA is associated with increased complications including limited or no care coordination for high-risk pregnancies or complications during delivery, prolonged or obstructed labor, inability to identify or treat hemorrhage or sepsis, and lack of information on HIV or malaria status [12,13].…”

Section: Introductionmentioning

confidence: 99%

Influence of Women’s Empowerment on Place of Delivery in North Eastern and Western Kenya: A Cross-sectional Analysis of the Kenya Demographic Health Survey

Anderson¹,

Chebet²,

Asaolu³

et al. 2020

JEGH

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KeywordsWomen's empowerment facility delivery childbirth North Eastern and Western Kenya A B S T R A C TBackground: Labor and delivery under the supervision of a skilled birth attendant have been shown to promote positive maternal and neonatal outcomes; yet, more than a third of births in Kenya occur outside a health facility. We investigated the association between measures of women's empowerment and health facility-based delivery in Northeastern and Western Kenya.Methods: Analysis of 2014 Kenya Demographic and Health Survey data was conducted. Logistic regression adjusting for demographic factors, contraceptive use, and comprehensive HIV knowledge was used to assess the influence of the validated African Women's Empowerment Index-East (AWEI-E) on the likelihood of women's most recent birth having occurred in a health facility versus at home. Additionally, we explored the mediating effect of contraceptive use on women's empowerment and health facility-based delivery.Results: Compared to respondents with low or moderate empowerment scores, those with high empowerment scores were more likely to have given birth at a health facility [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.30, 2.51], although this effect was null in the adjusted model (OR = 0.92, 95% CI = 0.58, 1.45). Respondents with a recent facility birth (n = 372/836) were more likely to have high household-level wealth (40.9% vs 8.6%, p < 0.001) and use a contraceptive method (44.9% vs 27.4%, p < 0.001) than those without facility-based delivery. Current contraceptive use mediated 26.8% of the effect of empowerment on the odds of facility-based delivery. Conclusion:Women's empowerment, and its comprising three domains as measured by the AWEI-E, may be insufficient to overcome barriers to facility-based delivery for women in North Eastern or Western Kenya. High women's empowerment is strongly associated with current contraceptive use, which may inform pregnancy planning and location of delivery. Alternatively, higher empowered women who delivered at a facility may have been offered contraceptives at the time of delivery. Future research targeting these regions should explore culturally acceptable approaches to broadening access to skilled supervision of labor.

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“…Few health interventions have greater potential impact on the overall health of society than good quality facility-based, care to women while pregnant and during and after childbirth. In Kenya, under the Free Maternity Policy (FMP), more women have been choosing to give birth in maternity care facilities rather than at home with traditional birth attendants (TBA) (1,2). Despite these gains, infant mortality and morbidity rates in Kenya remain unacceptably high and anecdotal evidence shows that not all pregnant women may be willing to attend facility care services.…”

Section: Introductionmentioning

confidence: 99%

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

Lusambili

Naanyu

Wade

et al. 2019

Preprint

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17 Background: Under the Free Maternity Policy (FMP), Kenya has witnessed an increase 18 health facility deliveries rather than home deliveries 19 with Traditional Birth Attendants (TBA) resulting in improved maternal and neonatal 20 outcomes. Despite these gains, maternal and infant mortality and morbidity rates in 21 Kenya remain unacceptably high indicating that more work needs to be done. 22 Aim: Using data from the Access to Quality Care through Extending and Strengthening 23 Health Systems (AQCESS) project's qualitative gender assessment, this paper 24 examines and describes women's experience of disrespectful care during pregnancy, 25 labour and delivery. The goal is to promote improved understanding of actual care 26 conditions in order to develop interventions that can lift the standard of care, increase 27 maternity facility use, and improve health outcomes for both women and newborns. 28 Methodology: We conducted sixteen focus group discussions (FGDs) with female 29 adolescents, women, men and community health committee members. Twenty four key 30 informants interviews (KII) including religious leaders, local government representatives, 31 Ministry of Health (MOH) and local women's organizations were conducted. Data were 32 captured through audio recordings and reflective field notes. 33 Research site: Kisii and Kilifi Counties in Kenya. 3 34 Findings: Findings show Nursing and medical care was sometimes disrespectful, humiliatings, 35 uncompassionate, and neglectful. In both sites, male health workers were the most preferred by women 36 as they were friendly and sensitive. Young women were more likely to be abused and women with 37 disabled children were stigmatized. 38 Conclusions: Kenya needs to enforce the implementation of the quality of care guidelines for pregnancy 39 and delivery, including respectful maternity care of pregnant women. To make sure these procedures are 40 enforced, measurable benchmarks for maternity care need to be established, and hospitals need to be 41 regularly monitored to make sure they are achieved. Quality of care and compassionate and 42 caring staff may lead to successful and sustainable use of facility care. 43

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The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities

Cited by 102 publications

References 19 publications

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

Influence of Women’s Empowerment on Place of Delivery in North Eastern and Western Kenya: A Cross-sectional Analysis of the Kenya Demographic Health Survey

Deliver on Your Own: Disrespectful Maternity Care in rural Kenya

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