Women’s preferences for place of delivery: a study of Embakasi-North and Naivasha Sub-County’s, Kenya

Aridi, J. K. O.
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Strathmore University
High maternal mortality continues to affect many sub-Saharan African countries. Kenya continues to have an unacceptable high maternal mortality ratio. Despite a rise in coverage for facility-based delivery following a free maternity services policy in 2013, there is little data on what women value when making their decision in choosing a place of delivery. There is uncertainty regarding factors that influence women’s choice of health facilities and women’s perceptions of quality of care. This study sought to examine women’s preferences and to rank attributes of the health system that drive women’s choices. The study compared the preferences of women in Embakasi North a peri-urban setting in Nairobi County with those in a rural Naivasha sub-County. It utilized a mixed methods study incorporating a qualitative study and a quantitative study approach; a Discrete Choice Experiment (DCE) for evaluating the factors that women value when selecting their place of delivery. In Naivasha, women ranked the highest attribute preference as the presence of a kind and supportive attitude of healthcare worker (β=1.184, p<0.001), whereas in Embakasi-North sub- County the women’s highest preference was for the attribute on cleanliness of the health facility, (β=1.488, p<0.001).This was followed by availability of medical equipment and drugs in both the Naivasha (β=1.073, p<0.001), and Embakasi-North (β=1.435, p<0.001). The attribute ranked third for Naivasha was the quality of clinical services during delivery (β=0.826, p<0.001) whereas in Embakasi-North it was the alternative specific constant (β=1.424, p<0.001). The coefficient for both the distance to the health facility and cost of delivery for Naivasha (β=0.457p<0.001) and (β=0.00002, p<0.001) respectively and Embakasi-North (β=0.339, p<0.001) and (β= p<0.0002) were positive and statistically significant at the 1 % level. These results indicate a preference for high costs and long distance which contradict economic theory that predicts that most rationale people would have a preference for low costs and short distances respectively. This implies that women were bypassing closer health facilities and seeking care at further off health facilities. The cost result implies that women were willing to pay higher costs for services that they perceive would be of higher quality. The study established that sociodemographic such as age, marital status, income status and education level all influence the ranking of attributes with the exception of cost and distance in Embakasi-North. These findings suggest that women value both structural and process indicators of quality of care. Patient-centered aspects of care matters to women. By paying attention to their preferences, policy makers can provide care that women want and value. To prevent bypass of closer health facilities and promote affordable care, policy makers should provide care that has the requisite medical equipment and respectful healthcare workers that are responsive to women’s needs. This will assist in meeting the Sustainable Development Goals (SDGs) targets for reducing preventable maternal mortality. Keywords: Women preferences, place of delivery, Kenya, Discrete Choice Experiment
Full - text thesis
Aridi, J. K. O. (2020). Women’s preferences for place of delivery: A study of Embakasi-North and Naivasha Sub-County’s, Kenya [Strathmore University]. http://hdl.handle.net/11071/15402