Maternal and Child Health Journal

, Volume 13, Issue 1, pp 130–137 | Cite as

What does Access to Maternal Care Mean Among the Urban Poor? Factors Associated with Use of Appropriate Maternal Health Services in the Slum Settlements of Nairobi, Kenya

  • Jean-Christophe Fotso
  • Alex Ezeh
  • Nyovani Madise
  • Abdhallah Ziraba
  • Reuben Ogollah
Article

Abstract

Objectives The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. Methods The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Results Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Conclusion Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.

Keywords

Maternal health Urban poor Health facility delivery Kenya 

Notes

Acknowledgments

The authors acknowledge the financial support from the World Bank that enabled the collection of the data used in this study (Grant # 713 6587) and the design of the research questions addressed in this paper (Grant # 304 406-29). Special thanks to Dr. Sam Mills from the World Bank for his technical support and guidance during the data collection, and to Ms Rose Oronje from APHRC for reviewing earlier versions of the manuscript. The authors were funded by the Wellcome Trust grant # GR 078 530M and the Hewlett Foundation support grant # 2006–8376.

References

  1. 1.
    World Health Organization. (2005) The World Health Report 2005: Make every mother and child count. Geneva: World Health Organization.Google Scholar
  2. 2.
    Ronsmans, C., & Graham, W. J. (2006). Maternal mortality: Who, when, where, and why. The Lancet, 368(9452), 1189–1200.CrossRefGoogle Scholar
  3. 3.
    Filippi, V., Ronsmans, C., Campbell, O. M. R., Graham, W. J., Mills, A., Borghi, J., Koblinsky, M., & Osrin, D. (2006). Maternal health in poor countries: The broader context and a call for action. The Lancet, 368(9546), 1535–1541.CrossRefGoogle Scholar
  4. 4.
    World Health Organization. (2004). Making Pregnancy Safer. Fact Sheet No. 276, World Health Organization, Geneva.Google Scholar
  5. 5.
    World Health Organisation. (2004). Maternal Mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. World Health Organization.Google Scholar
  6. 6.
    Campbell, O. M. R., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. The Lancet, 368(9543), 1284–1299.CrossRefGoogle Scholar
  7. 7.
    Mahler, H. (1987). The safe motherhood initiative: A call to action. The Lancet, 1, 668–670.CrossRefGoogle Scholar
  8. 8.
    Koblinsky, M., Matthews, Z., Hussein, J., Mavalankar, D., Mridha, M. K., Anwar, I., Achadi, E., Adjei, S., Padmanabhan, P., & van Lerberghe, W. (2006). Going to scale with professional skilled care. The Lancet, 368(9544), 1377–1386.CrossRefGoogle Scholar
  9. 9.
    AbouZahr, C., & Wardlaw, T. (2001). Maternal mortality at the end of the decade: Signs of progress? The Bulletin of the World Organization, 79, 561–568.Google Scholar
  10. 10.
    Starrs, A. (2006). Safe motherhood initiative: 20 years and counting. The Lancet, 368(9542), 1130–1132.CrossRefGoogle Scholar
  11. 11.
    United Nations. (2000). United Nations Millennium Declaration. New York.Google Scholar
  12. 12.
    Lawn, J. E., Cousens, S., & Zupan, J. (2005). Four million neonatal deaths: When? Where? Why? The Lancet, 365, 891–900.CrossRefGoogle Scholar
  13. 13.
    Matrix Development Consultants. (1993). Nairobi’s informal settlements: An inventory. A Report prepared for USAID/REDSO/ESA. Nairobi: USAID.Google Scholar
  14. 14.
    Central Bureau of Statistics. (2000). Welfare Monitoring Survey III: Government Priorities. Nairobi: Ministry of Planning and National Development.Google Scholar
  15. 15.
    Ministry of Health [Kenya], National Council for Population and Development [Kenya], and ORC Macro. (2000). Kenya Service Provision Assessment Survey 1999. Calverton, Maryland: Ministry of Health, National Council for Population and Development, and ORC Macro.Google Scholar
  16. 16.
    Zulu, E., Dodoo, F. N., & Ezeh, C. A. (2002). Sexual risk-taking in the slums of Nairobi, Kenya, 1993–1998. Population Studies, 56, 311–323.PubMedCrossRefGoogle Scholar
  17. 17.
    Magadi, M. A., Zulu, E. M., & Brockerhoff, M. (2003). The inequality of maternal health care in urban sub-Saharan Africa in the 1990s. Population Studies, 57(3), 347–366.PubMedCrossRefGoogle Scholar
  18. 18.
    Fotso, J. C. (2006). Child health inequities in developing countries: Differences across urban and rural areas. International Journal for Equity in Health, 5, 1.CrossRefGoogle Scholar
  19. 19.
    Tim, I. M., & Lush, L. (1995). Intra-urban differentials in child health. Health Transition Review, 5, 163–190.Google Scholar
  20. 20.
    Gould, W. T. S. (1998). African mortality and the new ‘urban penalty. Health and Place, 4, 171–181.PubMedCrossRefGoogle Scholar
  21. 21.
    Fotso, J. C. (2007). Urban-rural differentials in child malnutrition: Trends and socioeconomic correlates in sub-Saharan Africa. Health and Place, 13, 205–223.PubMedCrossRefGoogle Scholar
  22. 22.
    APHRC (African Population and Health Research Center). (2002). Population and Health Dynamics in Nairobi’s Informal Settlements. Nairobi (Kenya): African Population and Health Research Center.Google Scholar
  23. 23.
    National Coordinating Agency for Population and Development (NCAPD), Ministry of Health (MOh), Central Bureau of Statistics (CBS), and ORC Macro: Kenya Service Provision Assessment Survey 2004. NCAPD, MoH, CBS, ORC Macro: Nairobi, 2005.Google Scholar
  24. 24.
    Dunteman, G. H. (1989). Principal Component Analysis. Newbury Park: SAGE publication.Google Scholar
  25. 25.
    Hollander, D. (2004). Antenatal education helps Turkish women adopt health-promoting behavior. International Family Planning Perspectives, 30(1), 45–46.Google Scholar
  26. 26.
    Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15, 259–267.CrossRefGoogle Scholar
  27. 27.
    Peterson, B. L., & Harrell, F. E. J. (1990). Partial proportional odds models for ordinal response variables. Applied Statistics, 39(2), 205–217.CrossRefGoogle Scholar
  28. 28.
    Ananth, C. V., & Kleinbaum, D. G. (1997). Regression models for ordinal response: A review of methods and applications. International Journal of Epidemiology, 26(6), 1323–1333.PubMedCrossRefGoogle Scholar
  29. 29.
    Williams, R. (2006). Generalized ordered logit/partial proportional odds models for ordinal dependent variables. The Stata Journal, 6(1), 58–82.Google Scholar
  30. 30.
    Magadi, M. A., Madise, N. J., & Rodrigues, R. N. (2000). Frequency and timing of antenatal care in Kenya: Explaining the variations between women of different communities. Social Science & Medicine, 51(4), 551–561.CrossRefGoogle Scholar
  31. 31.
    Onah, H. E., Ikeako, L. C., & Iloabachie, G. C. (2006). Factors associated with the use of maternity services in Enugu, southeastern Nigeria. Social Science & Medicine, 63(7), 1870–1878.CrossRefGoogle Scholar
  32. 32.
    Sunil, T. S., Rajaram, S., & Zottarelli, L. K. (2006). Do individual and program factors matter in the utilization of maternal care services in rural India? A theoretical approach. Social Science & Medicine, 62(8), 1943–1957.CrossRefGoogle Scholar
  33. 33.
    APHRC (African Population and Health Research Center) and the World Bank. (2007). The Plight of Orphans and Vulnerable Children in Nairobi Urban Slums in the Face of HIV/AIDS: APHRC and the World Bank.Google Scholar
  34. 34.
    Graham, W. J., Bell, J. S., & Bullough, C. H. W. (2001). Can skilled attendance at delivery reduce maternal mortality in developing countries? Studies in HSO & P, 17, 97–129.Google Scholar
  35. 35.
    Mills, S., & Bertrand, J. T. (2005). Use of health professionals for obstetric care in Northern Ghana. Studies in Family Planning, 36(1), 45–56.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Jean-Christophe Fotso
    • 1
  • Alex Ezeh
    • 1
  • Nyovani Madise
    • 1
    • 2
  • Abdhallah Ziraba
    • 1
  • Reuben Ogollah
    • 1
  1. 1.African Population and Health Research Center (APHRC)NairobiKenya
  2. 2.School of Social SciencesUniversity of SouthamptonSouthamptonUK

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