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. 2025 Aug 22;22(1):150.
doi: 10.1186/s12978-025-02107-w.

Determinants of health facility choice for delivery among women participating in group antenatal care in Machakos county, kenya: A cross-sectional survey

Jefferson Mwaisaka  1 , Pooja Sripad  2 , Melanie Olum  3 , Patricia Owira  3 , Samuel Mwaura  4 , Rhoda Njeru  4 , Daniel Muli  5 , Faith Mutisya  5 , Anne Hyre  2 , Lisa Noguchi  2 , Stephanie Suhowatsky  2
Affiliations

Determinants of health facility choice for delivery among women participating in group antenatal care in Machakos county, kenya: A cross-sectional survey

Jefferson Mwaisaka et al. Reprod Health. .

Abstract

Background: Group antenatal (G-ANC) care has been introduced in Kenya and is associated with increased ANC contacts. Previous studies did not report higher likelihood of facility-based deliveries, where facility delivery rates are high (> 80%). It is unknown whether G-ANC influences women's choice of delivery facility. This study sought to understand if and how exposure to and experience of G-ANC, among other factors, influence women's decisions on which facility to deliver. Study findings can inform health system strategies including the Service Delivery Re-design.

Methods: We conducted a cross-sectional survey from December 2023 to January 2024 in eight health centers in Machakos County, Kenya with women who participated in G-ANC and had a facility delivery to understand women's choice of health facility for childbirth, i.e., whether they returned to the same G-ANC facility for delivery or went to another facility. The survey interviews were administered through telephone, as a nested component of a larger implementation research focused on the adoption of G-ANC.

Results: Of the 470 women who participated in the phone survey, 29.8% of women returned to deliver at the facility where they received G-ANC and 70.2% delivered elsewhere. Most women (84.3%) delivered in the public sector. Regression analysis models revealed two significant predictors for delivery in the same G-ANC facility: proximity to the facility (adjusted AOR 4.13, 95% CI: 2.73-6.23, p < 0.001); and positive staff attitudes (adjusted AOR 4.68, 95% CI: 2.06-10.60, p < 0.001). Two significant predictors of delivering in a different facility were being "told/advised to give birth there during pregnancy/ANC" (adjusted AOR 0.23, 95% CI: 0.15-0.35, p < 0.001) and high household wealth status (quintile four AOR 0.29, 95% CI: 0.09-0.91, p = 0.034; quintile five AOR 0.23, 95% CI: 0.07-0.72, p = 0.011). Intervention exposure was not significant.

Conclusion: Most women participating in G-ANC chose to deliver in another facility. The choice of facility for childbirth was most strongly influenced by factors other than the intervention, such as proximity, positive staff attitudes, health advice, and household wealth status.

Keywords: Delivery choice; Group antenatal care; Kenya.

Plain language summary

Group antenatal care (G-ANC) is an alternative service delivery model introduced in select public health facilities in Kenya. G-ANC was not associated with increased facility delivery in Kenya, where most women (over 80%) already deliver in health facilities. However, it’s unclear if and how G-ANC affects women’s choice of where to give birth, which is important for understanding care-seeking behaviors for maternal services as health systems invest in G-ANC and other health systems strengthening strategies. We surveyed 470 women in Machakos County who participated in G-ANC in eight study health centers and delivered in a health facility. The goal was to find out where they delivered and whether G-ANC influenced that decision. The survey was conducted by phone between December 2023 and January 2024 as part of a larger study on G-ANC. The results showed that 70.2% delivered at a different facility and 29.8% delivered at their G-ANC facility. Women were more likely to choose a different facility if they were advised to deliver there during pregnancy or if they came from wealthier households. Women were more likely to deliver at their G-ANC facility if it was close to home or if they had positive experiences with staff there. The G-ANC intervention did not directly influence facility choice. Findings suggest that proximity, staff attitudes, health advice, and household wealth influence delivery facility choice more than other factors. These findings can guide future county and national programming on G-ANC and other health system strategies aiming to improve maternal health outcomes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study received ethical review and approval from Johns Hopkins Bloomberg School of Public Health Institutional Review Board, Baltimore, Maryland, USA (21094) and AMREF Ethics and Scientific Review Committee, Nairobi, Kenya (P1219-2022). Research assistants received a four-day training on ethical conduct of research including the purpose, risks, benefits, and voluntary nature of the study, as well as the informed consent process. All participants were fully informed about the study before providing their consent. Participation was entirely voluntary. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Type of facility where G-ANC participants delivered
See this image and copyright information in PMC

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