Background: Childbirth at health facilities is an important strategy to reduce maternal morbidity and mortality,
improve fetal outcomes, and reduce mother-to-child transmission of HIV. Although access to antenatal care in
Kenya is high (>90%), less than half of births occur at health facilities. This analysis aims to assess correlates of facility
delivery among recently pregnant HIV-infected women participating in a community-based survey, and to determine
whether these correlates were unique when compared to HIV-uninfected women from the same region.
Methods: Women residing in the Kenya Medical Research Institute/Centers for Disease Control and Prevention
Health and Demographic Surveillance System, and who had delivered an infant in the previous year were visited
at home in 2011. Consenting mothers answered a questionnaire assessing demographics, place of delivery, utilization
of prevention of mother-to-child HIV transmission (PMTCT) services, and stigma indicators. Known HIV-positive women
were purposively oversampled. Chi-square tests of proportions and multivariate logistic regression, stratified by HIV
status, were performed to assess correlates of facility delivery.
Results: Overall, 101 (46.8%) HIV-infected and 127 (39.9%) HIV-uninfected women delivered at health facilities. Among
HIV-infected women, cost (42.8%), distance (18.8%) and fear of harsh treatment (15.2%) were primary disincentives for
facility delivery; 2.9% noted fear of HIV testing was a disincentive. HIV-infected women who delivered at facilities had
higher education (p = 0.04) and socioeconomic status (p < 0.005), initiated antenatal care (ANC) earlier (4.9 vs.
5.4 months, p = 0.016), were more likely to know partner’s HIV status (p = 0.016), report satisfaction with delivery
care (p = 0.001) and use antiretrovirals (87.1% vs. 77.4%, p = 0.063) compared to those with non-facility delivery.
Stigma indicators were not associated with delivery location. Similar cofactors of facility delivery were noted
among uninfected women.
Conclusions: Utilization of facility delivery remains low in Kenya and poses a challenge to elimination of infant HIV
and reduction of peripartum mortality. Cost, distance, and harsh treatment were cited as barriers and these need
to be addressed programmatically. HIV-infected women with lower socioeconomic status and those who present
late to ANC should be prioritized for interventions to increase facility delivery. Partner involvement may increase
use of maternity services and could be enhanced by couples counseling.