FACTORS INFLUENCING THE CHOICE OF FACILITY BASED DELIVERY AMONG

PRIMIGRAVIDA ATTENDING BUNGOMA COUNTY REFERRAL HOSPITAL

PAMELA JERUTO KIMELI

D/NURS/20009/2918

A RESEARCH DISSERTATION TO BE SUBMITTED TO KENYA

MEDICAL TRAINING COLLEGE FOR THE AWARD OF DIPLOMA IN
COMMUNITY HEALTH NURSING

KENYA MEDICAL TRAINING COLLEGE

BUNGOMA CAMPUS

OCTOBER , 2024
 CHAPTER ONE: INTRODUCTION

1.1 Background Information

The choice of facility-based delivery is a critical aspect of maternal health, particularly for
primigravida (first-time mothers). Globally, the trend towards institutional deliveries has been
influenced by various factors, including socio-economic status, cultural beliefs, accessibility to
healthcare services, and the perceived quality of care. According to the World Health
Organization (WHO), skilled attendance at birth is essential for reducing maternal and neonatal
morbidity and mortality rates (World Health Organization, 2020).

Globally, there has been a significant push towards increasing the rates of facility-based
deliveries as part of efforts to improve maternal health outcomes. The WHO recommends that all
births should be attended by skilled health personnel to ensure safety and reduce complications
(World Health Organization, 2020). However, disparities exist between different regions; while
developed countries report high rates of institutional deliveries, many developing nations still
struggle with low uptake due to various barriers.

In Thailand, substantial improvements in maternal health have been achieved through

government initiatives that promote facility-based deliveries. The Thai government has
implemented policies aimed at enhancing access to healthcare services and improving the quality
of care in hospitals (Boonmongkon et al., 2019). These efforts have resulted in increased rates of
institutional deliveries among primigravida women.

Sub-Saharan Africa faces significant challenges regarding maternal health. Despite global efforts
to improve access to healthcare services, many women still deliver at home due to cultural
beliefs, lack of transportation, and inadequate healthcare infrastructure (Mokodokwa et al.,
2020). In this region, it is crucial to understand the socio-cultural dynamics that influence
women’s choices regarding delivery methods.

Liberia presents a unique case within Sub-Saharan Africa where civil conflict has severely
impacted healthcare systems. Many women in Liberia continue to deliver at home due to fear of
inadequate medical facilities or lack of trained personnel (Kumar et al., 2018). Addressing these
issues requires targeted interventions that consider local contexts and cultural practices.
Ethiopia has made notable strides in increasing facility-based deliveries through community
engagement and education programs aimed at changing perceptions about childbirth (Feleke et
al., 2019). The Ethiopian government’s commitment to improving maternal health has led to
increased investments in healthcare infrastructure and training for healthcare providers.

In Kenya, the government has implemented policies aimed at promoting skilled attendance
during childbirth as part of its broader strategy for achieving Universal Health Coverage (UHC)
(Ministry of Health Kenya, 2020). However, despite these efforts, disparities persist across
different regions including Bungoma County where cultural beliefs and economic factors
significantly influence women’s choices regarding place of delivery.

Bungoma County is located in Western Kenya and reflects many challenges faced by rural areas
in accessing quality maternal healthcare services. Factors such as distance from health facilities,
financial constraints, and traditional beliefs play a significant role in determining whether
primigravida women choose facility-based delivery or opt for home births (Wamalwa et al.,
2020). Understanding these factors is crucial for developing effective interventions that can
enhance the uptake of facility-based deliveries among this population.

1.2 Problem statement

Globally, maternal mortality remains a pressing public health issue, with approximately 295,000
women dying during and following pregnancy and childbirth in 2017 (World Health
Organization, 2019). The majority of these deaths occur in low-resource settings where access to
quality healthcare is limited. Facility-based deliveries are associated with improved outcomes
due to the presence of trained healthcare professionals who can manage complications
effectively (Betrán et al., 2016).

The choice of facility-based delivery among primigravida (first-time mothers) is a critical

determinant of maternal and neonatal health outcomes. In Bungoma County, Kenya, the
prevalence of facility-based deliveries remains suboptimal despite various interventions aimed at
promoting institutional births. According to the Kenya Demographic and Health Survey (KDHS)
2020, only 61% of births in Bungoma County occur in health facilities, which is significantly
lower than the national average of 79% (Kenya National Bureau of Statistics [KNBS], 2020).
This disparity raises concerns about the factors influencing this decision among primigravida
women.

Several socio-economic, cultural, and healthcare system-related factors may contribute to the
low rates of facility-based deliveries. For instance, studies indicate that lack of financial
resources, inadequate transportation options, and cultural beliefs surrounding childbirth play a
significant role in women’s choices regarding delivery locations. A survey conducted by the
Ministry of Health revealed that approximately 30% of women cited financial constraints as a
barrier to accessing facility-based care (Ministry of Health, 2021). Furthermore, local customs
and traditions can discourage women from seeking institutional care during childbirth; for
example, some communities believe that delivering at home is safer or more culturally
appropriate.

Understanding these factors is essential for developing targeted interventions to improve facility-
based delivery rates among primigravida in Bungoma County. The need for comprehensive
research on this topic is underscored by the fact that complications arising from unassisted home
deliveries contribute significantly to maternal morbidity and mortality rates in the region
(Okwero, 2017). According to WHO estimates, approximately 810 women die every day from
preventable causes related to pregnancy and childbirth globally (World Health Organization
[WHO], 2021). Therefore, addressing the barriers faced by primigravida women in choosing
facility-based delivery is crucial for enhancing maternal health outcomes and achieving
Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-
being for all at all ages.

The severity of this issue is underscored by the high maternal mortality ratio in Kenya, which
stands at 342 deaths per 100,000 live births (Karanja, 2016). In Bungoma County specifically,
the maternal mortality rate is estimated to be even higher due to inadequate access to skilled birth
attendants and emergency obstetric care (Muliira, et al. 2019. Addressing these influencing
factors is essential for improving the rates of facility-based deliveries among primigravida and
ultimately enhancing maternal and neonatal health outcomes in the region.

Despite efforts to promote facility-based deliveries among primigravida women in Bungoma

County Referral Hospital, there remains a significant gap between recommended practices and
actual behaviors. Understanding the multifaceted factors influencing this choice is essential for
developing targeted interventions aimed at improving maternal health outcomes. This study
seeks to explore these factors comprehensively within the context of global trends down to local
realities in Bungoma County.

1.3 Study Justification

The justification for this study lies in its potential to contribute to improved maternal health
outcomes through enhanced understanding of delivery choices among first-time mothers. The
following points outline the significance of this research:

Maternal mortality remains a pressing issue globally, particularly in low- and middle-income
countries where access to quality healthcare services is limited. By investigating the
determinants influencing facility-based deliveries, this study seeks to provide insights into
barriers faced by primigravida women in Bungoma County, thereby contributing to strategies
aimed at reducing maternal mortality rates.

Findings from this research can inform local health authorities and policymakers about specific
challenges faced by first-time mothers regarding facility-based deliveries. This information can
guide the development of targeted interventions such as community awareness programs,
transportation services, and improved healthcare infrastructure that cater specifically to the needs
of pregnant women.

Understanding the preferences and perceptions of primigravida women regarding facility-based

delivery can help healthcare providers tailor their services to meet these needs effectively. By
identifying factors such as cultural beliefs, economic constraints, and perceived quality of care,
healthcare systems can be improved to encourage more women to choose institutional births.

This study adds to the existing body of literature on maternal health by focusing specifically on a
rural Kenyan context where data may be limited or outdated. It will provide empirical evidence
that can serve as a basis for further research on maternal health issues in similar settings.

Engaging with communities through this research will foster dialogue about safe motherhood
practices and empower women with knowledge about their reproductive health choices.
Increased awareness can lead to greater acceptance of facility-based deliveries as a norm within
communities.

1.4. 1 Broad objective

To determine factors influencing the choice of facility based delivery among primigravida at
Pamus sub-location, Bungoma County.

1.4.2 Specific objective

1. To find out socio-demographic factors associated with choice of place of child delivery among
primigravida at Pamus sub-location, Bungoma County..

2. To explore facility factors that are associated with choice of place of child delivery among
primigravida at Pamus sub-location, Bungoma County.

[Link] establish cultural factors associated with choice of place of delivery among primigravida at
Pamus sub-location, Bungoma County.

1.5 Research questions

What are the socio-demographic characteristics (age, education level, marital status, income
level) of primigravida attending Bungoma County Referral Hospital that influence their choice of
place for child delivery?

How does the socio-economic status of primigravida affect their preferences for delivery
locations in Bungoma County?

Are there significant differences in the choice of delivery place among primigravida based on
their cultural background or ethnicity?

1.6 Study Limitations

The study may face several limitations, including:

  Sample Size: A limited number of participants may not fully represent all primigravida
women in Bungoma County.

 Self-Reporting Bias: Participants may provide socially desirable responses rather than
their true feelings or experiences regarding facility-based deliveries.

 Cross-sectional Design: The cross-sectional nature of this study limits causal inference
about relationships between variables.

1.7 Study Delimitation

This study will focus exclusively on primigravida women attending Bungoma County Referral
Hospital during a specified period and will not include multiparous women or those delivering at
home or other facilities.

1.8 Study Assumptions

The study operates under several assumptions:

 Primigravida women are aware of their options regarding childbirth.

 Participants will provide honest responses during interviews or surveys.

 The data collected will accurately reflect the current situation regarding facility-based
deliveries.

1.9 Conceptual Framework

The conceptual framework for this study illustrates how various factors interact to influence the
choice of facility-based delivery among primigravida women:

Social Demographic
factors

Choice of facility based delivery

Facility factors
 Cultural factors

In this framework:

 Socio-Economic Factors: Include income level, education, employment status.

 Cultural Beliefs: Encompass traditional practices, family influence, religious beliefs.

 Accessibility: Refers to distance from healthcare facilities, transportation availability.

 Quality Care Perception: Involves trust in healthcare providers and previous

experiences with medical care.

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References
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