Pregnant Women’s Intentions and Subsequent Behaviors Regarding Maternal and Neonatal Service Utilization: Results from a Cohort Study in Nyanza Province, Kenya

<div><p>Higher use of maternal and neonatal health (MNH) services may reduce maternal and neonatal mortality in Kenya. This study aims to: 1) prospectively explore women’s intentions to use MNH services (antenatal care, delivery in a facility, postnatal care, neonatal care) at <20 and 30–35 weeks’ gestation and their actual use of these services; 2) identify predictors of intention-behavior discordance among women with positive service use intentions; 3) examine associations between place of delivery, women’s reasons for choosing it, and birthing experiences. We used data from a 2012–2013 population-based cohort of pregnant women in the Demographic Surveillance Site in Nyanza province, Kenya. Of 1,056 women completing the study (89.1% response rate), 948 had live-births and 22 stillbirths, and they represent our analytic sample. Logistic regression analysis identified predictors of intention-behavior discordance regarding delivery in a facility and use of postnatal and neonatal care. At <20 and 30–35 weeks’ gestation, most women intended to seek MNH services (≥93.9% and ≥87.5%, respectively, for all services assessed). Actual service use was high for antenatal (98.1%) and neonatal (88.5%) care, but lower for delivery in a facility (76.9%) and postnatal care (51.8%). Woman’s age >35 and high-school education were significant predictors of intention-behavior discordance regarding delivery in a facility; several delivery-related factors were significantly associated with intention-behavior discordance regarding use of postnatal and neonatal care. Delivery facilities were chosen based on proximity to women’s residence, affordability, and service quality; among women who delivered outside a health facility, 16.3% could not afford going to a facility. Good/very good birth experiences were reported by 93.6% of women who delivered in a facility and 32.6% of women who did not. We found higher MNH service utilization than previously documented in Nyanza province. Further increasing the number of facility deliveries and use of postnatal care may improve MNH in Kenya.</p></div

Predictors of discordance between women’s intentions and behaviors regarding postnatal care: Kenya, 2013.

<p>Predictors of discordance between women’s intentions and behaviors regarding postnatal care: Kenya, 2013.</p

Intentions, behaviors and intentions to repeat behaviors regarding use of maternal and neonatal health services.

<p><i>Notes</i>: ANC, antenatal care; PNC, postnatal care; *of those with a live birth.</p

Focus Group Participants.

<p>Focus Group Participants.</p

Distribution of direct causes of death by phase of pregnancy.

<p>Distribution of direct causes of death by phase of pregnancy.</p

Proportion of pregnancy-related deaths by phase of pregnancy and year of death.*

<p>*Note - prior to 2008, VA questionnaire asked for all miscarriages/abortions (spontaneous or induced); as of 2008, the WHO VA questionnaire was adopted which only asked for induced abortions.</p

Pregnancy-related mortality ratio in women 15–49 years by year of death and area.

<p>Pregnancy-related mortality ratio in women 15–49 years by year of death and area.</p

Classification of major causes of pregnancy-related deaths.

<p>A. Directly Ascribed Pregnancy-Related Mortality Causes B. Indirectly Ascribed Pregnancy-Related Mortality Causes.</p

Distribution of pregnancy-related and non-pregnancy-related deaths of women 15–49 years by socio-demographic and health-related characteristics.^a

a<p>Data provided are complete for some variables (gender, age, year death), but for others are not always completed on VA form.</p>b<p>Prior to 2008, VA questionnaire asked for all miscarriages (spontaneous or induced). As of 2008, the WHO VA questionnaire was adopted which only asked for induced abortions.</p>c<p>SES (MCA) - socio-economic status (multiple correspondence analysis, in quintiles, 1 = poorest; 5 = least poor).</p>d<p>Only generated in 2008.</p>e<p>Distance to nearest health facility.</p

Distribution of indirect causes of death by phase of pregnancy.

a<p>Other [all other non-infectious causes] (15) = liver (1), CVD (2), injuries (3), cancers (2), gastro (2), kidney (1), lung (1), CNS (2), other (1).</p