Why women prefer to give birth at home

Good massaging skills and “comfort” offered by traditional birth attendants are some of the reasons making more women prefer delivering at home instead of hospitals.

Others choose to deliver at home for fear of verbal abuse and harassment by nurses and doctors in the health centres, according to a new government report.

Traditional birth attendants, the women say, massage their abdomens and offer them all the comfort they need during labour.

In a quarter of women in group discussions under the Kenya Service Provision Assessment Survey 2010, whose results were released on Tuesday, at least one woman talked about abuse, lack of respect, neglect and general mistreatment they expected from nurses and doctors.

The claims could partly explain why only 43 per cent of women give birth in healthcare facilities countrywide.

According to the survey, 26 per cent of women interviewed would rather take the risk of delivering through the help of traditional birth attendants than face the “harsh” treatment by health staff.

Fifty discussions with between eight and 12 women each were analysed to assess the mothers’ perspectives on healthcare services available to them.

“Doctors and nurses in maternity abuse and sometimes even beat the women,” says the survey based of feedback from the women groups.

An even bigger proportion of women, 30 per cent, said they did not want to deliver at health facilities because they feared to take an HIV/Aids test.

It is now a general requirement in most health facilities to subject expectant mothers to an HIV test as women attend antenatal clinics or just before child birth so health staff can put in place measures to handle the newborn and the mother in case they test positive.

Some women’s groups in Coast and Western provinces said they were afraid even to attend antenatal care for fear of being tested for HIV.

Others said they avoid giving birth in health facilities because they were uncomfortable being examined by male attendants.

According to the findings, some expectant mothers chose to deliver at home because they had not had any complications with previous births at home.

Some said traditional birth attendants treated them better. “The traditional birth attendant will pamper me,” a woman said.

Most women of a group in Western Province said they had delivered at home. One said: “I have given birth to all my children at home. By God’s grace, I don’t get any complications.”

Generally, women said traditional birth attendants treated them well compared to staff of health facilities, who “often act disrespectfully to women, particularly during labour and delivery”.

“Most (women) go to traditional birth attendants because they will pamper you as opposed to the hospitals where you may end up being beaten up,” said a woman from Nairobi. “I was mocked by the attendants for crying,” she said.

The traditional birth attendants were praised for their skills in massage during antenatal care and labour, mostly by women in Western and Rift Valley.

In a quarter of the groups of women interviewed, at least one of them talked about abuse, lack of respect, neglect and general mistreatment they expected from nurses.

“Several women have the impression that women in labour are sometimes beaten,” says the survey. In Western Province, women said staff resorted to verbal or physical abuse.

“Young women hear of bad experiences in hospitals from their friends,” said a woman from North Eastern who added: “They are afraid and opt to give birth at home.”

In nearly half of discussion groups under the study, women said lack of money was one of the key reasons for not using delivery services at the health facility.

Delivery at health facilities, especially public and non-profit-owned ones, cost between Sh880 and Sh2,000 on average.

Some women said some of the health facilities were not clean. The untidy environments discourage women from using services for fear of being infected.

The need to address cleanliness is urgent in some of the health facilities, according to the report.

“It is possible when you go to the labour wards, you will find other women, for example six, together. Attending to all of them is difficult.”

Nonetheless, women who said they preferred delivery in public hospitals to their homes said there were better healthcare at the facilities.

Most of them said they chose delivery in health facilities because they would receive immediate assistance if complications arose during childbirth.

“The hospital is good because sometimes you can deliver with complications and you will be attended to by specialists,” said a woman from Coast.

“If they are not there, they will provide an ambulance to transfer you to a better hospital,” she said. But some fail to make it to hospitals due to lack of transport.