Predictors of Unskilled Birth Attendance among Women of Reproductive Age: A case of Kilifi county, Kenya DOI: https://dx.doi.org/10.4314/ajhs.v38i2.6

Abstract

Background: Globally, 59% of women deliver at home, predominantly in rural sub-Saharan Africa, compared to a 61% global rate for skilled birth attendance. In Kilifi County, Kenya, 85% of births are attended by skilled professionals, below the national average of 89%. The study aimed to explore predictors of unskilled birth attendance among women in Kilifi North and South Sub-counties, Kenya.

Methods: A cross-sectional study was conducted among 372 women aged 18 to 49 years. Participants were eligible if they were either pregnant at the time of the interview or had previously given birth, regardless of whether the delivery was attended by a skilled or unskilled birth attendant. The data obtained was analysed using STATA version 14, where Logistic regression analysis was conducted to identify predictors of unskilled birth attendance.

Results: Of the 372 women interviewed, 76 (20.4 %) reported delivering under unskilled birth attendance. The predictors of unskilled birth attendance included older maternal age (35+ years) [AOR=2.21; 95% CI: 1.19–4.16; p=0.013], higher gravidity (≥4 pregnancies) [AOR=4.27; 95% CI: 2.22–8.60; p<0.001], and being widowed or single [AOR=2.26; 95% CI: 1.19–4.30; p=0.013]. Experiencing danger signs during pregnancy was associated with reduced odds of unskilled birth attendance [AOR=0.54; 95% CI: 0.31–0.96; p=0.036]. Education level showed a protective association in unadjusted models, with tertiary education yielding the lowest odds.

Conclusions: Age, income, education, and healthcare access barriers significantly hinder women's use of skilled birth attendants. Cultural practices, traditional preferences, and societal perceptions also impact childbirth decisions. Distant travel to health facilities hinders timely access, particularly in emergencies. Additionally, maternal knowledge, driven by education and awareness, plays a crucial role in reducing risks for mothers and newborns.

Recommendations: To improve uptake of skilled birth attendance, targeted community education and culturally sensitive outreach should be explored, especially for older and high-parity women. Strengthening healthcare infrastructure, engaging traditional birth attendants in referrals, deploying mobile clinics, and increasing male involvement in maternal health are critical steps toward addressing access barriers and changing community perceptions.