Determinants of utilization of antenatal care services in karachuonyo north sub-county, homabay county, kenya

Abstract

Evidence has shown that Mothers who use ANC services, especially those who complete the WHO recommended four antenatal visits have higher likelihood of having childbirth in health facility and hence reducing incidences of pregnancy related deaths. On the other hand, Mothers who do not attend ANC or do not complete the visits are likely to experience maternal deaths related to pregnancy. Despite Kenya government policy of offering free maternity services including free antenatal care services, pregnant mothers are still not maximizing the uptake of ANC and especially completing the recommended minimum four visits. Homa Bay is one of the counties contributing to high maternal mortality in Kenya. Most maternal deaths occur due to inadequate utilization of antenatal and post-natal services. Challenges to maternal health in the county arise from an interplay of social, cultural, economic, and logistical barriers. Rachuonyo North sub county, located in Homa Bay county shares the same health challenges as Homa Bay county. This study sought to investigate the determinants of utilization of antenatal care services by mothers in Rachuonyo North Sub-County, Homa Bay County, Kenya with the objective of assessing the factors affecting utilization of ANC services. Specific objectives were to: a) Determine the proportion of mothers of reproductive age utilizing ANC services; b) Identify socio-cultural factors influencing utilization of ANC services by mothers of reproductive age; c) Determine the economic factors influencing access to ANC services by mothers of reproductive age and; d) Determine the influence of the perceptions of the mothers of reproductive age on utilization of ANC services. The study used descriptive cross-sectional study design. Women who had at least one pregnancy three years prior to the study were eligible for selection in the study. Multistage sampling was used to reach the study participants. Rachuonyo North Sub-County was purposively selected for the study. Simple random sampling was used to select 5 locations from East Rachuonyo division and six locations from West Rachuonyo division in Rachuonyo North Sub-County. Nine sub locations and eight sub locations were also randomly selected from West and East Rachuonyo divisions respectively. The target population involved 5000 mothers who had given birth at least once in the last 3 years preceding the study from which a sample size of 329 mothers of reproductive 15-49 years’ age group were selected by multistage sampling procedure with participants subsequently selected through systematic random sampling technique. The data was collected and analysed using SPSS descriptive statistics to generate frequency tables, figures and Pearson chi-square tests to determine the relationship between independent and dependent variables. The results reveal that most (86.5%) of the mothers had utilized ANC services in their previous pregnancies citing awareness on the services provided at clinics as the reason for attendance. There was statistically significant relationship between the reasons of ANC clinic visits, religious affiliation, level of education of the mothers, decision making by husbands and ANC uptake (p-value of 0.000), number of deliveries and ANC uptake with p-values 0.003, 0.002 which are less than 0.05 significance level. In addition, there was no statistically significant relationship between marital staus, type of house and ANC uptake signified by p-values of 0.123, 0.414 which are greater than 0.05 significance level. With regard to economic factors; whereas there was statistically significant relationship between income, cost incurred during clinic attendance and the utilization of ANC services by the mothers as evidence by p-values of 0.010 and 0.001, there was no statistically significant relationship between either the mothers or their husbands’ occupation on ANC utilization as depicted by p-values of 0.989 and 0.947 respectively. Mothers perceptions relating to poor services at the clinics, availability of alternative assistance (TBA and relatives), complications, feeling of shame do influence ANC uptake although taboos prohibiting discussing pregnancy did not influence ANC uptake.