Community perspectives on barriers in access to maternity services in Mbita, Kenya

Background: In 2008, 342,900 women died from maternal causes, 99% of them in developing countries. While Kenya is among the 30 poorest countries in the world, Mbita fares worse than the national average on maternal mortality, which is estimated at 780 per 100,000 live births. Over 50% of women deliver at home in this area, despite the availability of a maternity center. Objective: This qualitative assessment aimed to understand facilitators and barriers to utilization of available maternity services in Mbita, Kenya as well as preferences for care during pregnancy, delivery, and the postpartum period. Methods: In-depth interviews were conducted with women from the community, as well as selected men, traditional birth attendants (TBAs), and staff at Mbita Maternity Center. Topics included health practices during pregnancy and preferences for maternal care. Results: Of 51 women interviewed, 53% had their last delivery at home. They reported high utilization of antenatal care and a strong consensus that the facility was the safest place to deliver. Major barriers to utilization of biomedical care included lack of resources for transportation and payment for delivery, fear of and harsh treatment from staff at the maternity center, failure to address traditional practices at the maternity center, and preference for care by familiar and trusted TBAs. Conclusion: Several recommendations were made to improve maternity care in this area, including conducting an in-depth needs assessment at the maternity center to understand how best to support staff and improve care and building partnerships between the TBAs and the maternity center.