Persistent Utilization of Unskilled Birth Attendants’ Services among Maasai Women in Kajiado County, Kenya

Abstract

Despite recommendations for skilled reproductive health (RH) attendance, the contrary persists in sub-Saharan Africa. This study described the utilization of Unskilled Birth Attendants’ (UBA) services among women after adoption of the 2007 Kenyan RH policy. The services offered to women by Traditional Birth Attendants (TBAs) and factors associated with this persistent utilization of unskilled care were studied. A total of 328 Maasai women, 15 TBAs and 3 key informants participated in the study. Questionnaires, interviews and 28 days TBA activities’ register were used to collect data. The study area was selected purposively due to high utilization of UBAs while women were sampled randomly. Odds ratios, 95% C.I. and inferential statistics at p <0.05 compared those utilizing unskilled care with those who did not. Most women, 84.1% (276) utilized unskilled RH services at least once and 68% during delivery alone. TBAs offered RH services to 453 clients in 28days. Of those services, 36.4%, 35.3%, 25.2% and 3.1% were antenatal, delivery, postnatal and family planning respectively. Low education, advanced age and high parity were significantly associated to UBA utilization at p<0.05. The persistent utilization of UBAs services was attributed to availability of UBAs, ignorance of and poor access to skilled services. Skilled attendance can be improved by marketing the services, redirection of UBAs to offer safe services and improving RH infrastructure.