Nyakang'o, S.B. and Booth, A orcid.org/0000-0003-4808-3880 (2018) Women's perceived barriers to giving birth in health facilities in rural Kenya: A qualitative evidence synthesis. Midwifery, 67. pp. 1-11. ISSN 0266-6138
Abstract
Background: In Kenya, uptake of skilled care during birth remains lower in rural areas when compared to urban areas, despite efforts by the government to encourage facility-based births by abolishing maternity fees in public health facilities. Objective: To synthesise published and unpublished qualitative research that explores women's perceived barriers to facility-based birth in rural Kenya. Design: Qualitative evidence synthesis Data sources: Multiple electronic databases (MEDLINE, EMBASE, PsycINFO, POPLINE, CINAHL, Web of Science and ProQuest), grey literature searches, citation chaining and checking of reference lists. Review methods: Studies were screened by title, abstract and full text, after which a standardised qualitative checklist was used to assess study quality. Synthesis of extracted data followed the ‘best-fit’ framework method, enhanced with a pathway-based model for the improvement of maternal and newborn care. Results: Sixteen eligible studies were identified. Key themes were: (i) knowledge, attitudes and practices, including past experiences of health facilities and community beliefs about facility services; (ii) insufficient demand for professional care caused by the perceived advantages of seeking alternative care during birth and the disadvantages of facility-based births; (iii) limited access to services, especially in rural areas, because of poor infrastructure; (iv) misconceptions regarding labour characteristics and, (v) poor awareness of labour outcomes. Conclusions: Important factors can be characterised as ‘push’ factors (those pushing women away from facilities) and ‘pull’ factors (those related to the relative advantage of facility-based births). However, key to an individual woman's decision are factors relating to knowledge, attitudes and practices and awareness of labour outcomes. While a critical tension exists between government policy and consumer choice, the prevalence of inadequate awareness and the dominance of past experiences and community beliefs offer significant obstacles to a woman in making an informed choice about her preferred place of giving birth.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 Elsevier. This is an author produced version of a paper subsequently published in Midwifery. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
Keywords: | Barriers; Birth, obstetric; Kenya; Parturition; Review |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 19 Nov 2018 12:13 |
Last Modified: | 19 Aug 2019 00:40 |
Published Version: | https://doi.org/10.1016/j.midw.2018.08.009 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.midw.2018.08.009 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:138572 |