Factors influencing utilization of free maternity care services among pastoralist women in Isiolo county, Kenya

Abstract

Maternity care service (MCS) supports women during pregnancy, delivery, and postpartum. While 86% of global pregnant women access maternity care, only 44% of Kenyan women do. In Isiolo County, maternity care use has varied, not meeting the 80% target: 61% in 2016, dropping to 52% in 2017, then 69% in 2018, down to 53% in 2019, and 64% in 2020 which is attributed to the free maternity healthcare services that were expanded after the introduction of the Linda mama initiative in 2017. This study aimed to pinpoint factors affecting pastoralist women's use of free maternity services in Isiolo, focusing on cultural impact, education, and healthcare infrastructure. Grounded in the theory of planned behavior, a descriptive cross-sectional design was used. A descriptive research design was used to conduct the study. A sample of 380 pastoralist women was obtained from a target population of 73,877 women aged 19-49 years. The study used a census sampling to sample the three sub-counties in Isiolo County, purposive sampling to sample the birth attendants and simple random stratified sampling to sample the pastoralist women. Data was collected from three sub counties names Merti, Isiolo and Garba Tula in Isiolo County. Both quantitative and qualitative data was collected using questionnaire and key informant interviews. Data was analyzed using descriptive and content analysis. The relationship between the independent variables (culture, knowledge of pastoralist women and healthcare infrastructure) and dependent variable (utilization of free maternity healthcare) was analyzed using a multiple regression analysis. The findings were presented in table format and narration format. The study found that 80.1% of participants said their culture promotes home births, reducing the use of free maternity care. Only 38% were aware of free maternity services, with most maternal decisions in Isiolo County made by men as indicated by 87.4% of respondents. Infrastructure for maternity care was found lacking (63.9%), with only one theater facility for multiple sub-counties. Based on the interviews conducted, it was established that Isiolo County has one theater facility in the Isiolo sub-county, a challenge that greatly affects the pastoralist women from the Merti and Garba Tula sub-counties. The multiple regression revealed that culture negatively affects the utilization of free maternity care while knowledge and healthcare infrastructure positively influence the uptake of free maternity healthcare services. The study is significant to the County government of Isiolo, which can use the results to establish mobile medical facilities to promote the uptake of free maternity care services. The study recommended that policy makers should integrate the pastoralist culture into the healthcare services provided. Moreover, the study recommended that policy makers should create policies that ensure the healthcare facilities take up the responsibility of educating the pastoralist women and their husbands on the importance of seeking free maternity healthcare services.