Factors Contributing to Homebirths in Mutwot Location, Nandi North District

Abstract

Background: Worldwide more than half of all births occur at home. The World Health Organization estimates that more than 1,000 women die daily from childbirth related complications and 99% of these maternal deaths occur in developing countries. In Kenya, homebirths account for 40% of all deliveries. In Nandi North District, 59% of all deliveries occur at home. In the year 2008/2009, 25% of mothers that presented late in labour to the Mosoriot Health Center had birth related complications. Therefore, in order to come up with effective maternal health promotion strategies in Kenya, there is need to understand the factors contributing to home deliveries.

Objectives: The main objective of the study was to determine the factors contributing to homebirths in Mutwot Location, Nandi North District. Specifically, to determine the prevalence of homebirths in Nandi North, determine factors that influence preference for homebirths in Nandi North, and determine the community's perceived attitude towards hospital births.

Study Design: A cross-sectional descriptive study involving 75 postnatal mothers selected by using systematic sampling procedures at the MCH/FP clinic at Mosoriot Rural Health Centre. The researchers obtained data from the mothers via an interview schedule questionnaire. 

Study Findings: Majority (95%) of the mothers attended antenatal clinic at least once before the birth of the baby. The highest number (72%) of those that attended clinic sought the antenatal services of Mosoriot Health Centre. The antenatal visit happened in the second trimester of pregnancy for the majority (51%) of those that attended.The prevalence of homebirths was 29%, those who opted for it mentioned the TBA proximity to her home, and the flexible modes of payment for services rendered as the major underlying reasons. Forty seven percent (47%) of the respondents had no previous home delivery, 29% had delivered once at home, while 15% had two previous births at home. Among those who gave birth at home, 44% cited the availability of the TBA as the main reason, while 24% mentioned long distance to the hospital as a hindrance. Among mothers who had homebirths in the past, an overwhelming majority (92%) have never experienced any complications. The most common homebirth complication encountered was excessive bleeding. An overwhelming majority (99%) of respondents would prefer to give birth in a health facility. The majority (51%) of mothers admitted in a health facility for labor and claimed to have benefited from specialized care, with 41% believing that birth complications are rare in case of hospital delivery. 

Conclusion: The rate of homebirths is low within the Nandi North. The major reasons for continued practice of homebirths are largely the availability of TBAs and the acceptable modes of payment for their services. The fact that the majority of respondents sought specialized health facility care for the mother and the newborn is indeed an encouraging affront in the reduction of maternal and infant mortality rates. Despite access to a TBA, majority of community members still hold hospital services in high regard.

Recommendation: The Ministry of Health should strengthen and sustain health communication approaches to create awareness for the continued need of skilled maternity services. The low level of education among the mothers in Nandi North warrants further research to determine if the practice of early marriage is the contributory factor for this finding or it could imply that education has little value attached to it compared to marriage.