Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care

Abstract Background Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek...

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Main Authors: Ntemena Kapula, Stephen Shiboski, Christine Dehlendorf, Linet Ouma, Patience A. Afulani
Format: Article
Language:English
Published: BMC 2022-11-01
Series:BMC Pregnancy and Childbirth
Subjects:
Online Access:https://doi.org/10.1186/s12884-022-05111-1
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author Ntemena Kapula
Stephen Shiboski
Christine Dehlendorf
Linet Ouma
Patience A. Afulani
author_facet Ntemena Kapula
Stephen Shiboski
Christine Dehlendorf
Linet Ouma
Patience A. Afulani
author_sort Ntemena Kapula
collection DOAJ
description Abstract Background Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors—perceived need, accessibility, and quality of care—that influence the use of SBAs. Methods We used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15–49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects. Results Overall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69–5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43–17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles. Conclusion Our results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors – particularly perceived accessibility and quality of care – warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care.
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spelling doaj.art-62cabb773f5b48f193415768d09c110b2022-12-22T03:58:07ZengBMCBMC Pregnancy and Childbirth1471-23932022-11-0122111110.1186/s12884-022-05111-1Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of careNtemena Kapula0Stephen Shiboski1Christine Dehlendorf2Linet Ouma3Patience A. Afulani4Department of Epidemiology and Biostatistics, University of California, San FranciscoDepartment of Epidemiology and Biostatistics, University of California, San FranciscoDepartment of Epidemiology and Biostatistics, University of California, San FranciscoCenter for Clinical Research, Kenya Medical Research InstituteDepartment of Epidemiology and Biostatistics, University of California, San FranciscoAbstract Background Giving birth in health facilities with skilled birth attendants (SBAs) is one of the key efforts promoted to reduce preventable maternal deaths in sub-Saharan Africa. However, research has revealed large socioeconomic status (SES) disparities in facility-based childbirth. We seek to extend the literature on the factors underlying these SES disparities. Drawing on the Disparities in Skilled Birth Attendance (DiSBA) framework, we examined the contribution of three proximal factors—perceived need, accessibility, and quality of care—that influence the use of SBAs. Methods We used data from a survey conducted in Migori County, Kenya in 2016, among women aged 15–49 years who gave birth nine weeks before the survey (N = 1020). The primary outcome is facility-based childbirth. The primary predictors are wealth, measured in quintiles calculated from a wealth index based on principal component analysis of household assets, and highest education level attained. Proposed mediating variables include maternal perceptions of need, accessibility (physical and financial), and quality of care (antenatal services received and experience of care). Logistic regression with mediation analysis was used to investigate the mediating effects. Results Overall, 85% of women in the sample gave birth in a health facility. Women in the highest wealth quintile were more likely to give birth in a facility than women in the lowest quintile, controlling for demographic factors (adjusted odds ratio [aOR]: 2.97, 95% CI: 1.69–5.22). College-educated women were five times more likely than women with no formal education or primary education to give birth in a health facility (aOR: 4.96; 95% CI: 1.43–17.3). Women who gave birth in health facilities had higher perceived accessibility and quality of care than those who gave birth at home. The five mediators were estimated to account for between 15% and 48% of the differences in facility births between women in the lowest and higher wealth quintiles. Conclusion Our results confirm SES disparities in facility-based childbirth, with the proximal factors accounting for some of these differences. These proximal factors – particularly perceived accessibility and quality of care – warrant attention due to their relationship with facility-birth overall, and their impact on inequities in this care.https://doi.org/10.1186/s12884-022-05111-1Socioeconomic statusPerceived needAccessibilityQuality of careFacility deliverySkilled birth attendance
spellingShingle Ntemena Kapula
Stephen Shiboski
Christine Dehlendorf
Linet Ouma
Patience A. Afulani
Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care
BMC Pregnancy and Childbirth
Socioeconomic status
Perceived need
Accessibility
Quality of care
Facility delivery
Skilled birth attendance
title Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care
title_full Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care
title_fullStr Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care
title_full_unstemmed Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care
title_short Examining socioeconomic status disparities in facility-based childbirth in Kenya: role of perceived need, accessibility, and quality of care
title_sort examining socioeconomic status disparities in facility based childbirth in kenya role of perceived need accessibility and quality of care
topic Socioeconomic status
Perceived need
Accessibility
Quality of care
Facility delivery
Skilled birth attendance
url https://doi.org/10.1186/s12884-022-05111-1
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