Approaching Barriers to Health Center Deliveries in Rural Western Kenya from a Liberation Theology Perspective: A Community-Based Needs Assessment

Abstract

Maternal health services play a vital role in optimizing pregnancy outcomes, especially for high-risk women in developing countries. In order to understand why few women utilize such services, extensive interviews were conducted on the Nyakach Plateau in rural western Kenya. Within a sample of 90 native Luo women (43 pregnant and 47 non-pregnant), 97.87% of the pregnant women intended to deliver at a health center, but only 45.00% of previously pregnant mothers actually did. Within the larger context of liberation theology, Paul Farmer MD PhD contrasts “structural” barriers with “cognitivist-personalistic” barriers and recommends that studies elucidate which of these problems is primary. His own work has shown that knowledge and values are irrelevant if “structural violence” prevents people from taking advantage of services. This study similarly identified and categorized the major determinants of health center deliveries into accessibility versus knowledge and values. When weighing their relative contributions, it becomes clear that the women in this sample desired to deliver in a health center but faced significant accessibility barriers. That these problems are crucial is emphasized by the fact that 38.30% of the previously pregnant mothers have other serious problems impacting or resulting from pregnancy, including HIV/AIDS, death of a child, delivering a sick baby, or having chronic physical consequences from a difficult delivery. Of the entire sample, 92.22% reported a transportation barrier. Women in labor must hike across rough terrain for an average of 3 miles to seek appropriate medical care. The other two most commonly identified barriers were financial issues (75.56%) and a lack of services (64.44%). In spite of knowledge and values, these conclusions direct significant intervention efforts toward accessibility barriers, particularly transportation aid, to increase the number of health center deliveries. Although specific to the Nyakach Plateau, these findings can be generalized to similar impoverished communities in the developing world.