Understanding Home Delivery Preferences: The Role of SocioEconomic and Cultural Factors in Marsabit County, Kenya

Abstract

Home deliveries, defined as childbirth occurring outside hospital settings without the assistance of skilled healthcare providers, remain common in some regions despite substantial efforts to improve maternity and newborn health services. This study aimed to assess the influence of cultural factors on the preference for home deliveries in rural Marsabit County, Kenya. A descriptive cross-sectional mixed-methods design was employed, with 396 women participating in quantitative surveys and additional qualitative data gathered from 10 interviews and 2 focus group discussions. Quantitative data were processed using descriptive statistics and logistic regression, while qualitative data were thematically coded. The analysis revealed that the point prevalence of home deliveries among women of reproductive age in Marsabit County was 64.65% (n = 256, 95% CI [59.81%, 69.49%]), with 189 (55.26%) of those who had ever delivered at home reporting between 1 and 3 home deliveries. Additionally, 291 (94.17%) of home deliveries were attended by traditional birth attendants (TBAs), highlighting the significant role TBAs play in maternal health in this community. Cultural beliefs and family influence significantly shaped delivery choices, with family cultural influence reducing the likelihood of choosing a healthcare facility for delivery (OR = 0.47, 95% CI: [0.19, 0.81], p = 0.009). Socio-economic conditions, including higher education levels (OR = 1.854, p < 0.001) and stable employment (OR = 2.776, p = 0.007), were strongly associated with an increased likelihood of facility-based deliveries. The study concluded that an integrated approach addressing cultural and socio-economic factors are crucial for promoting safer delivery practices. Recommendations include integrating TBAs into the formal healthcare system and enhancing communication strategies to build trust in government health programs.