Barriers to Utilization of Skilled Birth Attendance Among Post-Natal Women in North Horr Ward, Marsarbit County, Kenya

Despite government efforts to expand access, reliance on unskilled birth attendants (UBAs) persists in the remote parts of North Horr Ward. Understanding drivers, including economic, sociocultural, and health systems dimensions, is imperative for targeted interventions promoting a shift to skilled attendance. This study aimed to examine barriers to the utilization of skilled birth attendance among women in North Horr Ward, Marsabit County, with specific aims of assessing potential demographic, economic, sociocultural, and health facility barriers that facilitate home deliveries. A mixed methods approach was used, where a survey questionnaire captured quantitative data from 306 women (mean age=33 years), and 15 semi-structured interviews were conducted to support the quantitative findings. Quantitative data were analyzed through descriptive and inferential statistics using Stata version 15, while qualitative data were analyzed thematically using NVIVO and presented in tabular form. The results showed that only the age group had a significant association with the place of last delivery (p<0.0001). 92% (n=281) were married, 97% (n=297) had children, and unemployment was 98% (n=300). Costs of transport, poor infrastructures, and lack of money were significantly associated with place of delivery (p<0.0001). 50% (n=153) reported a health facility as the place of last delivery, while 47% (n=144) delivered at home. All health facility factors were significantly associated with the place of last delivery (p<0.0001), though sociocultural factors like TBA availability (80% [n=123]) influenced the choice. The regression model showed no significant relationships for sociocultural barriers (p>0.05). Qualitative findings revealed financial constraints, sociocultural norms, and health infrastructure deficits as major barriers to skilled birth attendance utilization. In conclusion, multifaceted barriers interact as obstacles to the utilization of skilled birth attendance among women in North Horr Ward, Marsabit County. Initiatives aimed at improving skilled birth attendance utilization must judiciously tackle poverty, remoteness, inconsistent quality of care, and traditional mindsets.