Influence of free maternity delivery policy on safe Motherhood in Mandera county, Kenya

Abstract

More than half a million women die globally from pregnancy and childbirth-related causes. In Kenya maternal deaths are 488/100000 live births. Since maternity fee exemption policy is enhances the utilisation of skilled birth attendants and reduction of maternal mortality, it was introduced in Kenya in 2013 in line the Sustainable Development Goals. Unfortunately, despite the free maternity policy in Kenya, Mandera County continues to exhibit very worrying maternal health indicators with maternal mortality ratio of 3795/100,000 live birth and low skilled delivery of 38%. This trend requires empirical analysis into the dynamics of the implementation of this innovative policy. Such policy relevant study is critical to provide evidence for decision- making, policy reforms and to inform ongoing programs as well as academic debates. Against this backdrop, this study evaluated the effect of free maternity delivery policy on safe motherhood in Mandera County. Specific objectives of the study examined factors that influence implementation of free maternity policy, determining factors that influence utilization of free maternity policy and analyzed trends in the utilization of skilled delivery since the inception of the policy in Mandera County. Guided by the Donabedian‘s SPO framework used to evaluate the quality of medical care (Donabedian, 1966. The study adopted correlation study design. Study population was 38,978 women who delivered during the implementation of free maternity policy and 150 health care-workers who are implementing the policy. Sample size of 340 households was determined using the Cochran formula (1977). Employing systematic, simple random, proportionate and multi-stage sampling techniques to execute quantitative aspects of the study, 340 mothers and 67 health workers from 9 health facilities in the sampled area were recruited to fill the tailored structured questionnaires. Qualitatively, Focus Group interview schedules (FGDs) interview schedules were used to guide 3 FGDs among the mothers, while key informant interview schedule was used to collect data from 9 health facility in-charges. Descriptive statistics and regression analysis were conducted on quantitative data while thematic analysis was used to analyze qualitative data. Data was presented through narratives, charts, figures and frequency tables. The main finding of this study is that while the free maternity policy is a key innovation toward reducing maternal and child mortality and associated problems, the extent of its implementation is dependent on the circumstances sounding beneficiaries and implementers. Specifically, the study found that access and utility of skilled delivery exhibited a positive trend during the period of implementation of free maternity policy; however, qualitatively, the outcome cannot be said to be positive since factors including attitudes of service providers, user fees charged, distance to the health facility, impeded implementation and utilisation of the policy. This study recommends that the policy should be implemented with a focus on contextual determinants of its success in an area like Mandera County. This can be through incremental adjustment to the policy to address the broader aspect of continuum of care for safe motherhood, institutional factors that affect implementation and social-cultural and economic factors that influence utilisation.