Treads in development related factors associated with women undergoing voluntary surgical contraception in Nairobi province, Kenya
An intricate relationship exists between economic development and maternal health. As a result, maternal health is being used as an indicator for development in the Millennium Development Goals. Goal number five seeks to reduce maternal mortality, which currently stands at 590 per 100,000 live births, by two thirds by 2015. The performance of bilateral tubal ligation (BTL) nearly abolishes risks associated with pregnancy in women. Hence, nearly all risks associated with maternal mortality end with performance of this operation. As such, BTL is a landmark family planning method that impacts directly on a country's development. The decision to do BTL however is influenced by many factors. These same factors affect maternal health and because they also affect development, maternal mortality becomes a relevant indicator for development as used in the Millennium Development Goals. Against this background, little is known about trends in factors that relate to maternal mortality and which are finally abolished by doing BTL. This comparative cross-sectional study defined trends in socio-demographic and reproductive health factors in women undergoing BTL in Nairobi and related the trends to socio-economic development. The trends were studied over the span 1994 to 2005. Data was obtained from 620 hospital records, half of these being for 1994 and half for 2004. Interviews were done with 310 antenatal clients and 30 key informants. In addition, 3 focus group discussions were conducted with ante-natal mothers. Data was managed using Statistical Package for Social Sciences (SPSS). The results showed that the age at which BTL is being done has risen from 32 to 34 years between 1994 and 2004 and is likely to rise further in future, a factor that is likely to increase maternal mortality and is a negative indicator of socio-economic development. Using ANOVA, the mean age at BTL was found to be significantly different among the centres of study (Pumwani, Aga Khan and FPAK). Tukey test showed that the difference arose from Pumwani having a consistently low age at BTL compared to the other centres. The number of living children remained consistent at 3 to 4 children before undergoing BTL. Paired t-test showed that there was a significant difference in parity and number of living children over the period. The correlation between parity and number of living children weakened from 0.92 to 0.86 over the period, a factor that increases risk of maternal mortality given that fewer pregnancies are leading to a desired number of living children with time. The influence of religion and traditional beliefs was found to play a weakening role in deciding on BTL with representations in women undergoing BTL coming from all the major religions. Empowerment and education of women were found to be on the increase and to play a positive role in choosing to have BTL. While only 10% of women undergoing BTL had post-secondary education in 1994, this figure rose to 33% in 2004. Further, it was found that 80% of married women would not undergo BTL without their husbands' consent, a position supported by 94% of key informants. It is recommended that women and key informants be educated on the dangers of pregnancies at ages above 35 years; that religions that oppose contraception review their stand as faithful disregard their advise; and that men be targeted with advocacy and education on the importance of BTL because women depend on them for consent to undergo the procedure. Players in the areas of population and development will find results of this study important in planning interventions to enhance socio-economic development in Nairobi.