A qualitative exploration of barriers to health facility-based delivery in Bomachoge Borabu and Kaloleni, Kenya.

OBJECTIVE Health facility-based delivery is associated with reduced maternal mortality. This study explores barriers to utilization of health facility-based delivery in Kenya. METHODS In April 2017, a qualitative study utilizing key informant interviews (KII) and focus group discussions (FGDs) was carried out in Bomachoge Borabu and Kaloleni, Kenya. Twenty-four KIIs were interviewed including health service providers, community health workers, religious leaders, local government representatives, Ministry of Health representatives, and representatives of women's organizations. Sixteen FGDs were held separately with adolescent females, adult females, adult males, and Community Health Committee members. Data were transcribed, coded, and categorized thematically to illustrate supply and demand side barriers to use of health facility-based delivery services. RESULTS Supply side barriers included staff shortages, inadequate supplies and space, poor interpersonal relations, few trained staff, long distance to services, poor transport infrastructure, and limited service hours. Demand side barriers included financial constraints, limited spousal support, observance of birthing traditions, limited knowledge on importance of health facility-based delivery, and fear of health facility procedures. CONCLUSIONS Diverse barriers continue to influence use of health facility-based delivery services in Kenya. Practical, integrated interventions are urgently needed to reduce barriers noted to further reduce the maternal mortality rate.