Utilization of Free Maternity Services among women Aged 18-49 Years in Machakos County, Kenya
Ngesa, Alice Mukunzu
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Globally, the rate of maternal mortality is unacceptably on the rise. Maternal mortality rates in Kenya remain high at 362 per 100,000 live births. Only 62% of women deliver under the care of a skilled provider indicating a deficiency in the quality of care. The government of Kenya introduced the policy of Free Maternity Services to all women attending public health facilities in June 2013 to increase skilled birth attendance and reduce inequality by making services available to all pregnant women. Despite the introduction and adoption of the free maternity policy in all government facilities, there is still low utilization of the free maternity services by pregnant women. The study sought to establish the determinants of utilization of free maternity services among postnatal women in Machakos County. A cross sectional study was carried out in Machakos County. A sample size of 421 postnatal women was proportionally selected from each ward through systematic random sampling and interviewed. The study mainly focused on the individual client characteristics, the client related factors and organizational factors related to utilization of free maternity services, which encompassed use of both quantitative and qualitative data collection methods. Both quantitative and qualitative data was collected. Necessary approvals were sought from relevant authorities and informed consent obtained from research participants prior to data collection. Descriptive data was analyzed using Statistical Package for Social Sciences version 25.0. Frequency distribution tables, graphs and pie charts were used for data presentation. Qualitative data was presented as direct quotes or narrations from respondents and triangulated with quantitative results. Inferential statistics were calculated using Fischer’s exact tests and chi-square test (p<0.05) done at 95% confidence interval to establish the association between study variables. The study found out that the overall utilization level of free maternity services by respondents was 75.6%. Chi-square test showed significant statistical association between marital status (p=0.006), parity (p=0.038), distance from facility and utilization of free maternity services (p=0.000), satisfaction with maternity services offered during labour (p=0.000), treatment of mothers by healthcare workers during labour (p=0.000) provision of adequate food (p=0.005), maternity services offered were of high quality (p=0.000), maternity ward was not congested (p=0.009). Fischer’s exact test showed significant statistical association between cleanliness of the maternity ward (p=0.000), respect to clients by health workers (p=0.001) availability of bed/linen (p=0.002), satisfaction with labour ward services during delivery (p=0.000) with utilization of free maternity services. The study concludes that the utilization of FMS was optimal, organizational factors were majorly significantly associated with utilization of FMS.The study recommends that the department of health to support health facilities to offer FMS by providing the necessary supplies. These findings would assist key healthcare stakeholders to design strategic policies and initiatives to ensure sustenance of Free Maternity Services in the country. This would further ensure that the Free Maternity policy leads to improved quality of maternal service provision in all public hospitals thus increased utilization among women of reproductive age.