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Bypassing high-quality maternity facilities: evidence from pregnant women in peri-urban Nairobi.
Stein, Dorit T; Golub, Ginger; Rothschild, Claire W; Nyakora, George; Cohen, Jessica; McConnell, Margaret.
Afiliación
  • Stein DT; Department of Global Health and Population, Harvard T.H Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
  • Golub G; Innovations for Poverty Action, Sandalwood Lane, Next to the Sandalwood Apartments (off Riverside Drive), Nairobi 00200, Kenya.
  • Rothschild CW; Department of Epidemiology University of Washington 1959 NE Pacific Street Box 357236 Seattle, WA 98195, USA.
  • Nyakora G; Center for Health Solutions, 521-40600 Siaya, Kenya.
  • Cohen J; Department of Global Health and Population, Harvard T.H Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
  • McConnell M; Department of Global Health and Population, Harvard T.H Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
Health Policy Plan ; 36(1): 84-92, 2021 Mar 03.
Article en En | MEDLINE | ID: mdl-33263768
Utilization of high-quality maternal care is an important link along the pathway from increased facility-based delivery to improved maternal health outcomes, however women in Nairobi do not all deliver in the highest quality facilities available to them. We explored whether women living in peri-urban Nairobi who live nearby to high-quality facilities bypassed, or travelled farther than, their nearest high technical quality facility using survey data collected before and after delivery from women (n = 358) and from facility assessments (n = 59). We defined the nearest high technical quality facility as the nearest Comprehensive Emergency Obstetric and Newborn Care (CEmONC) capable facility to each woman's neighbourhood. We compared women who delivered in their nearest CEmONC (n = 44) to women who bypassed their nearest CEmONC to deliver in a facility that was farther away (n = 200). Among bypassers, 131 (65.5%) women delivered in farther non-CEmONC facilities with lower technical quality and 69 (34.5%) delivered in farther CEmONCs with higher technical quality capacity compared to their nearby CEmONCs. Bypassers rated their delivery experience higher than non-bypassers. Women who bypassed to deliver in non-CEmONCs were less likely to have completed four antenatal care visits and to consider delivering in any CEmONC prior to delivery while women who bypassed to deliver in farther CEmONCs paid more for delivery and were more likely to report being able to access emergency funds compared to non-bypassers. Our findings suggest that women in peri-urban Nairobi bypassed their nearest CEmONC facilities in favour of delivering in facilities that provided better non-technical quality care. Bypassers with access to financial resources were also able to deliver in facilities with higher technical quality care. Policies that improve women's delivery experience and ensure that information about facility technical quality is widely distributed may be critical to increase the utilization of high-quality maternity facilities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Instituciones de Salud / Servicios de Salud Materna Límite: Female / Humans / Newborn / Pregnancy País/Región como asunto: Africa Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Instituciones de Salud / Servicios de Salud Materna Límite: Female / Humans / Newborn / Pregnancy País/Región como asunto: Africa Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido