Healthcare System Factors Influencing Access and Utilization of Skilled Birth Services among Pastoralist Women in Loima Sub-County, Turkana County, Kenya

Background: Skilled birth attendance is a cornerstone intervention for reducing maternal and neonatal morbidity and mortality. Despite national policy efforts in Kenya, utilization of skilled birth services remains low among pastoralist communities. This study examined healthcare system factors influencing access and utilization of skilled birth services among women of reproductive age in Loima Sub-County, Turkana County.
Methods: A community-based cross-sectional study was conducted among 250 women aged 15–49 years who had delivered within the preceding 24 months. Data on healthcare system characteristics were collected using structured interviewer-administered questionnaires. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with utilization of skilled birth services.
Results: Utilization of skilled birth services was significantly associated with distance to health facilities, availability of 24-hour delivery services, availability of skilled health personnel, continuity of essential drug and supply availability, and presence of functional referral and emergency transport systems. After adjustment, distance greater than 10 km (AOR = 3.12; 95% CI: 1.89–5.14), lack of skilled staff (AOR = 2.47; 95% CI: 1.41–4.31), frequent stock-outs of maternity supplies (AOR = 1.96; 95% CI: 1.12–3.42), and absence of referral systems (AOR = 3.68; 95% CI: 2.01–6.74) remained independent predictors of non-utilization.
Conclusion: Healthcare system barriers substantially constrain access and utilization of skilled birth services in pastoral settings. Strengthening rural health systems through improved infrastructure, staffing, supply chains, and referral systems is essential for improving maternal health outcomes.

Medicine

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