CHAPTER ONE
BACKGROUND OF THE STUDY
Approximately 1000 women die each day worldwide from pregnancy related causes, 99% of them in developing countries and more than 50% in sub-Saharan Africa with most deaths concentrated around the time of delivery. An estimated 2.65 million stillbirths occurred in 2008 worldwide while 3 million new-borns do not survive the first month of life worldwide annually . Skilled assistance during childbirth, readily accessible appropriate care in case of complications and effective postnatal care within the first 24 hours of delivery are strategies that can improve perinatal outcomes for mothers and babies. A key strategy to reducing maternal and neonatal deaths is the ‘health-centre intrapartum care strategy’, where qualified skilled workers manage labour, effectively manage complications and are supported with effective referral systems for specialised care when needed, and an effective postnatal care package.
A significant proportion of mothers in developing countries still deliver at home unattended by skilled health workers. In diverse contexts, individual factors including maternal age, parity, education and marital status, household factors including family size, household wealth, and community factors including socioeconomic status, community health infrastructure, region, rural/urban residence, available health facilities, and distance to health facilities determine place of delivery and these factors interact in diverse ways in each context to determine place of delivery]. Eijk et al. looked at antenatal care and delivery care among women in Western Kenya and demonstrated that older women, high parity, lower socioeconomic status, low education levels and more than an hour walking distance were associated with delivery outside health facilities. Studying poor urban dwellers in Nairobi, Fosto et al. found from bivariate analyses that wealth, education, parity, place of residence were associated with place of delivery. Ochako has previously demonstrated that these factors together with marital status and age at birth of last child determined use and timing of first Antenatal Care (ANC) visit and type of delivery. There are also wide variations in the reasons women give for delivering at home between and within countries . For Kenya, recent studies looking at the degree of effect of such factors are lacking.