Determinants of delivery by skilled birth atendants among pregnant women in Makueni County, Kenya

Abstract

Background: Skilled birth attendants (SBAs) can improve outcomes during delivery and postpartum by detecting and managing early complications of pregnancy and labor. The objective of this study was to determine factors associated with SBA utilization among women seeking antenatal care at rural community health units in Makueni, Kenya where less than 37% of women deliver with SBAs. Methods: Pregnant mothers were recruited at antenatal care clinics, enrolled and interviewed at baseline, then followed until delivery and for six weeks post-partum. Sociodemographic characteristics, knowledge and attitudes were compared using Chi square test and independent t tests among those who utilized SBA services and those who did not. Results:From January 2012 to January 2013, 324 pregnant women were interviewed at baseline and again at 6 weeks postpartum, of whom 172 (54%) reported delivery with an SBA. Women with secondary school education and above were 1.8 times more likely to choose skilled attendance at delivery compared to those with less education (Odds ratio [OR] 1.8, 95% confidence interval [CI]: 1.02 – 2.60), and women with previous pregnancies were 40% less likely to utilize skilled attendance during delivery compared to nulliparous women (OR 0.6, CI: 0.40 – 0.95). Women with male partners who had greater than a secondary school education were more likely to delivery with an SBA present (OR), and there was a trend for pregnant mothers accompanied by their spouses to the delivery to be more likely to deliver in a health facility when compared to those accompanied by other birth companions (OR 1.4, CI: 0.73 – 2.78). Access to a vehicle as a mode of transport to the place of delivery was strongly associated with increased likelihood of delivery with an SBA (OR 24.1, CI: 14.82 – 42.64). At the postpartum visit, women stated that the amount of money they had spent for skilled delivery was $67 which was significantly higher than the $30 USD reported for unskilled delivery (p = 0.001). Conclusions: Several factors were identified as independently associated with mothers not utilizing skilled care during delivery (education level, parity, transport availability) and the cost of delivery with an SBA was found to be more than double the cost without an SBA Interventions targeting these factors could increase uptake of delivery by SBAs and improve maternal and infant health in rural Kenya and other parts of sub-Saharan Africa.