The Pull and Push Factors Influencing Choice of Place and Delivery Attendant in the Urban Slums of Nyalenda, Kisumu East District, Kenya
Celestine Atieno Okang, Dan Kaseje

Abstract
Back ground: Maternal and child mortality is a major problem facing developing countries. Access to quality care during pregnancy and child birth is a crucial factor for prevention of maternal mortality and morbidity. Cultural barriers have contributed to poor uptake in skilled delivery. Great Lakes University of Kisumu works in collaboration with ministry of health in the implementation of community health strategy as an intervention to improve maternal, new born and child health outcomes. A minority of women (34.7%) in peri-urban slums of Kisumu, did not change from using unskilled birth attendants in response to the intervention. This study investigated the pull and push factors influencing choice of place and delivery birth attendant from the perspectives of users and non-users of skilled delivery services. Method: This study was a comparative qualitative in design where data was collected by focused group discussions with women of reproductive age (15-49). Five focus groups were made up of women who used unskilled attendants during their last delivery. Another five groups were of women who used skilled attendants during the last delivery. The data collected were coded according to emerging themes and subthemes regarding factors influencing choice of place of delivery. Results: The factors pushing women away from skilled attendants included lack of cultural cleansing so that the a mother is able to have more children, poor quality of care, age gap between users and service providers creating privacy issues, inadequate continuity of care viewed by clients as negligence not matching the cost of care, inadequate supplies and barriers such as transport at the time of need as well as the comfort of caring family members. The main pull factors influencing the use of skilled attendants included comprehensiveness of care provided at health facilities, access to emergency services in case of complications, subsidy of cost of care. Conclusion: Many of the factors pushing away women from skilled attendants such as quality of care, transport barriers, and comfortable environment of care, can be addressed through better planning and preparedness of the clients and service providers. Factors attracting women to skilled attendants can be enhanced by increasing availability of comprehensive services, emergency care and affordability of services at the time of need through insurance and subsidy.

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