Factors influencing mothers' decisions regarding obstetrical care in Western Kenya: a mixed-methods study.
BACKGROUND
Siaya County in Western Kenya has one of the highest maternal mortality rates in Kenya. We sought to elucidate factors that influence mothers' decisions regarding where to seek obstetrical care, to inform interventions that seek to promote effective use of obstetric services and reduce maternal mortalities. To guide our research, we used the "Three Delays Model", focusing on the first delay-seeking care. While interventions to reduce maternal mortalities have focused on addressing delays in accessing and receiving care, context-specific data on drivers of the first delay are scarce.


METHODS
We used a mixed-method study to assess how maternal decision-making of birth location is influenced by personal, contextual, and cultural factors. We conducted structured interviews with women aged 14 years or older living in Siaya, Bondo, and Yala, rural districts in Western Kenya. We then conducted focus group interviews with a subset of women to elucidate this question: How do drivers of the first delay (i.e., seeking care) affect the decision to seek home versus hospital delivery, potentially negatively influencing maternal mortality.


RESULTS
Three hundred and seven women responded to the surveys, and 67 women (22%) from this group participated in focus group interviews. Although we focused on type 1 delays, we discovered that several factors that impact type 2 and type 3 delays directly contribute to type 1 delays. Our findings highlighted that factors influencing women's decisions to seek care are not simply medical or cultural but rather contextual, involving many elements of life, particularly in rural communities.


CONCLUSIONS
It is imperative to address multiple-level factors that influence women's decisions to seek care and have in-hospital deliveries. To curtail maternal mortality in rural Western Kenya and comparable settings, targeted interventions must take into consideration these important influencers.
['Umutesi|Grace|G|', 'McEvoy|Matthew D|MD|', 'Bonnet|Kemberlee|K|', 'Druffner|Sophie|S|', 'Schlundt|David G|DG|', 'Atieli|Harrysone E|HE|', 'China|Joy N|JN|', 'Onyango|Kennedy|K|', 'Newton|Mark W|MW|0000-0001-8135-879X']
D005260:Female D006297:Health Services Accessibility D006801:Humans D007630:Kenya D008427:Maternal Health Services D009035:Mothers D010342:Patient Acceptance of Health Care D011247:Pregnancy
Kenya Maternal mortality Three Delays Model Decision-making Healthcare seeking behavior Low-income countries