Crucial Barriers to Health Center Deliveries in Rural Western Kenya: Accessibility, Knowledge, or Values?

Crucial Barriers to Health Center Deliveries in Rural Western Kenya: Accessibility, Knowledge, or Values? I. Purpose Maternal health services play a vital role in optimizing pregnancy outcomes for high-risk women in developing countries. Despite increased services, Kenya in particular has made insufficient progress to reducing their maternal mortality and attaining Millennium Development Goal 5. In order to understand why few women utilize available services, this study identified and categorized the major determinants of health center deliveries into accessibility versus knowledge and values. II. Methods Extensive interviews were conducted on the Nyakach Plateau in rural western Kenya with 90 native Luo women (43 pregnant and 47 previously pregnant). Subjects were asked about accessibility barriers, pregnancy knowledge, their values concerning a health center delivery, as well as their intended versus actual delivery location. III. Results In this cross-sectional study, 98% of the pregnant women intended to deliver at a health center but only 45% of previously pregnant mothers actually did so. Almost 100% of the sample valued health center deliveries, but 92% reported a transportation barrier followed by financial problems (76%) and a lack of services (64%). 82% walked for an average of 3 miles to their prenatal care appointments, however 55% were unable to complete the journey over rough terrain when in labor. With the sample living almost four times closer to a traditional birth attendant than to a health center, these women faced significant structural barriers that left 38% with serious problems resulting from pregnancy (including HIV/AIDS, chronic physical consequences, and death). IV. Conclusions These conclusions direct significant intervention efforts toward accessibility barriers, particularly transportation aid, to increase the number of health center deliveries. Knowledge and values, although important, are irrelevant if structural barriers prevent access to health services. With these conclusions, a community-based program called Mothers On the Move (MOM) was started to provide expectant mothers with transportation to nearby health centers. To date, over 600 women have experienced positive birth outcomes at Sigoti Health Center and Nyabondo Hospital as a result of accessible maternal health services. Although specific to the Nyakach Plateau, these findings can be generalized to similar impoverished communities in the developing world.