Only 47% of the pregnant women make 4 recommended visits for antenatal care, 43% make institutional delivery and 44% have a skilled attendant during delivery (1).  Only 15 percent of women obtain antenatal care in the 1st trimester of pregnancy, and 52% receive care before the 6th month of pregnancy (4).  Kenya has one of world’s highest maternal mortality, with 490 deaths per 100000 live births (1).  Health seeking behavior amongst pregnant women is often determined by individual’s or household’s financial ability or barriers to seek care (2).  Lack of pre-natal care is one of the major reasons for maternal mortality (2).  Studies point towards the importance of health messages and advocacy for improving maternal and child health outcomes (3).  But not much research has been done on understanding the construct of women’s empowerment towards their ability to seek care.

1. HEALTH SEEKING BEHAVIOR AND EMPOWERMENT OF PREGNANT WOMEN IN KENYA
Poulomy Chakraborty
Department of Environmental and Global Health, University of Florida
 Only 47% of the pregnant women make 4
recommended visits for antenatal care, 43% make
institutional delivery and 44% have a skilled attendant
during delivery (1).
 Only 15 percent of women obtain antenatal care in
the 1st trimester of pregnancy, and 52% receive care
before the 6th month of pregnancy (4).
 Kenya has one of world’s highest maternal mortality,
with 490 deaths per 100000 live births (1).
 Health seeking behavior amongst pregnant women is
often determined by individual’s or household’s
financial ability or barriers to seek care (2).
 Lack of pre-natal care is one of the major reasons for
maternal mortality (2).
 Studies point towards the importance of health
messages and advocacy for improving maternal and
child health outcomes (3).
 But not much research has been done on understanding
the construct of women’s empowerment towards their
ability to seek care.
 To understand whether women’s empowerment influences
health seeking behavior of pregnant women of Kenya.
• Review of literature to understand the empowerment
status of women in Kenya and their association with
seeking care during pregnancy. Journal articles
provided background for the analysis.
• Reports from UN agencies and other organizations in
Kenya supported the overall analysis.
• Empowerment has been defined as the ability to make
health related decisions and choices either alone or
jointly with members of the household. It is the agency
of a woman to take informed decisions for her own
health care during pregnancy and child birth
• Data from the Kenyan Demographic and Health
Survey (2008-09) has been used. Variables from the
women’s questionnaire is used.
• Correlations, descriptive statistics and multivariate
associations have been tested to understand the study
objectives.
INTRODUCTION
METHODS
OBJECTIVE
• Studies show that for several household level decision making, it is the
men whose decisions prevails.
• Kenyan women have also been historically subjected to violence, which
may result in their lack of overall empowerment.
• Reliance of government hospitals for care seemed to be the most
common.
• The construct of women’s empowerment towards their ability to seek
care has not been well researched in the context of Kenyan community.
• More studies need to be done in this context.
• A high maternal mortality and lack of health seeking tendencies, along
with lack of decision making abilities towards their own health care,
raises the question of abilities of pregnant women to seek care.
1. UNICEF country statistics,
http://www.unicef.org/infobycountry/kenya_statistics.html
2. Gage AJ. Premarital childbearing, unwanted fertility and maternity care in Kenya and
Namibia. Pop Stud-J Demog 1998;52(1):21-34.
3. Fotso JC, Ezeh A, Madise N, Ziraba A, Ogollah R. What does Access to Maternal Care
Mean Among the Urban Poor? Factors Associated with Use of Appropriate Maternal
Health Services in the Slum Settlements of Nairobi, Kenya. Matern Child Hlth J
2009;13(1):130-37.
4. Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010. Kenya
Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro.
CONCLUSION
Fig 1: Pregnant women who sought antenatal /
prenatal care (N:3680)
Fig 3: Association between decisions on own health care (empowerment)
and health care sought
Final say on own health care
Independent variables Odds Ratio 95% CI
Educational attainment
No education
Incomplete primary 0.86 0.35 2.12
Complete primary 0.68 0.22 2.07
Incomplete secondary 0.49 0.14 1.71
Complete secondary 0.76 0.21 2.82
Higher 0.74 0.15 3.60
Employment
All year
Seasonal 1.48 0.81 2.69
Occasional 0.68 0.22 2.07
Household wealth index
Poorest
Poorer 0.82 0.33 2.06
Poor 1.97 0.71 5.51
Richer 1.73 0.57 5.27
Richest 3.63 1.02 12.99
Care sought
Doctor-prenatal 2.75 1.09 6.98
Government hospital 0.91 0.44 1.87
Government health center 0.50 0.23 1.10
Private hospital/clinic 0.50 0.20 1.26
Faith based/mission/church
hospital/clinic
0.79 0.30 2.09
N: 479
• Significant association between empowerment and prenatal
visits to doctor.
• High odds of seeking care in government hospital and faith
based hospitals
Amongst those pregnant women who sought care, most went to
government hospitals, doctors, or government health centers
0.329
0.301
0.262
0.096
0.063 0.006
0.004
0.002
Proportion
antenatal care government hospital
prenatal doctor
antenatal care government health centre
private hospital / clinic
faith based / mission/ church/hospital/clinic
nursing / maternity home
other public
other private
• Logistic regression, with final say on own health care as
the dependent variable
• Controlled for educational attainment, employment,
household wealth
• Not any significant association found in controlled
variables except seasonal employment and richest
households
69
17
43
94
31
85
68
82
53
0
10
20
30
40
50
60
70
80
90
100
tookirontablets/syrup
tookintestinalparasite
drugs
informedofsignsof
pregnancycomplications
weighed
heightmeasued
bloodpressuremeasured
Urinesampletaken
bloodsampletaken
giveninformationon
breastfeeding
Percent
Fig 2: Components of antenatal care (N:3680)
Quality of antenatal care is determined by the services offered.
Amongst those pregnant women who sought care, most went
were weighed, their blood pressure measured, urine and blood
samples measured.
REFERENCES