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International Journal for Quality in Health Care Advance Access originally published online on February 9, 2009
International Journal for Quality in Health Care 2009 21(2):79-86; doi:10.1093/intqhc/mzn058
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© The Author 2009. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Women's satisfaction with delivery care in Nairobi's informal settlements

Eva S. Bazant* and Michael A. Koenig

Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA

Objective. To quantify women's satisfaction with delivery care in informal settlements of Nairobi, Kenya, and to determine characteristics of women and delivery care associated with satisfaction.

Design. Household survey data analysis of 1266 women who delivered in health facilities in 2004 or 2005.

Setting. Two densely populated informal settlements 7 and 12 km from Nairobi's center, where residents work primarily in the nearby industrial area or in the informal sector.

Outcome. Satisfaction was assessed by whether women would recommend the delivery care facility and deliver there again.

Results. Over half (56%) of women would both recommend and deliver again in the same facility. In multivariate analysis, women's satisfaction with delivery care was associated with greater provider empathy (OR = 3.68, 95% CI 2.27, 5.97). Women's satisfaction with delivery care was also associated with the pregnancy having been wanted (OR = 2.75, 95% CI 1.82, 4.14) or mistimed vs. unwanted. Women delivering at private facilities in the settlement near the industrial area were more satisfied than women delivering at private facilities in the more distant and marginalized settlement (OR = 2.12, 95% CI 1.45, 3.09). The association of women's satisfaction and provider empathy was stronger among women who experienced complications compared to those who did not.

Conclusion. Health providers should be sensitized to the finding that unintended pregnancy is associated with lower satisfaction with delivery care. Maternal health programmes should focus on increasing provider empathy, especially for women who experience complications, in both private and government health facilities.

Keywords: delivery care, satisfaction, maternal health, Kenya, urban, quality

* Address reprint requests to: Eva S. Bazant, E-mail: ebazant{at}jhsph.edu

Accepted for publication November 14, 2008.


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