Examining Barriers to Maternal Health Care in Kenya Using The Three-Delay Framework

Abstract

Objective: This paper examines the impact of multiple per- ceived and actual barriers on the demand and utilization of preventive and emergency maternal health care in Kenya. Results were used to formulate comprehensive health pol- icy suggestions for future improvements in maternal health outcomes in Kenya. Method: Gabrysch & Campbell’s (2009) adapted version of Thaddeus & Maine’s (1994) “three-delay” framework was used to analyze the impact of four barriers-to-care on wom- en’s decision to seek preventive or emergency maternal care in Kenya. These barriers include: (1) physical accessi- bility, (2) economic accessibility, (3) the perceived benefits and quality of care, and (4) sociocultural obstacles. Each barrier may delay care-seeking outcomes in three phases: delay in considering to seek care (Phase I), delay in iden- tifying and reaching health facility (Phase II), and delay in receiving adequate and appropriate emergency obstetric care (Phase III). Results: While each barrier individually contributes to delays in care-seeking outcomes, they also interact synergistically within their contextual environments. Due to Kenya’s con- strained and debilitated health care system, quality of care represents a notable barrier for improving care-seeking out- comes. Conclusions: Improvements in the demand and utilization of maternal health care in Kenya requires the government to consider new legislative policies to strengthen its health care system, improve quality of care, and ensure the equal distribution of financial and human resources among the counties. Furthermore, it is critical that new maternal health interventions are developed upon a participatory communi- ty-based approach, involving a close partnership with com- munity leaders and local government ministries.