determinants of timing and spacing of pregnancies among women in the reproductive age in kajiado county, kenya.

Description

Globally, pregnancy and childbirth are the primary causes of maternal deaths. Early and closely spaced pregnancies are associated with adverse health outcomes. In 2019, 86% of maternal mortalities occurred in low-income nations. In Kenya, maternal mortality was at 362/100,000 live births. In addition, by the age of 18 years, 18% of all women had given birth and the unmet need for spacing pregnancy was at 9%. The main objective of the study was to investigate the determinants of timing and spacing of pregnancies among women in the reproductive age visiting the maternal and child health clinics in Kajiado Central Sub-County while, the specific objectives were to assess the proportions of knowledge on healthy timing and spacing, identify the timing and spacing patterns and determine the individual, health system and sociocultural factors associated with timing and spacing of pregnancies among women of reproductive age visiting maternal and child health clinics in Kajiado Central Sub-County. The study was conducted in 7 proportionately and randomly selected health facilities where, 248 participants were recruited and gave consent to participate in the descriptive cross-sectional mixed methods study. Moreover, the study conducted 2 focus group discussions with community health volunteers and 5 key informant interviews with health care workers. Quantitative data was analyzed by use of the statistical package for social sciences version 22. The association between independent and dependent variables was determined by use of the Chi square test, p < 0.05 was considered significant association. Qualitative data was classified into themes and reported verbatim. The research was approved by Kenyatta University Graduate School, ethical clearance was sought from Kenyatta University Ethics Review Committee and research permit obtained from National Commission for Science, Technology and Innovation. The study found that a majority (95%) of study participants did not have knowledge of the recommend minimum age at which women should have their first pregnancy and most of the study participants consisting of a proportion of 92.3% did not have knowledge on the recommended minimum interval for women to space pregnancy after a miscarriage. Study participants who had been pregnant before the age of 18 years were 33.6% while, almost half of the study participants, representing 45%, had an unhealthy pregnancy spacing interval after a live birth. The level of education (χ2 = 47.493; df = 4; p = 0.000), spouse’s level of education (χ2 = 39.399; df = 4; p = 0.000), occupation (χ2 = 22.966; df = 6; p = 0.000), spouse’s occupation (χ2 = 16.429; df = 5; p = 0.006), female genital mutilation (χ2 =22.757; df = 1; p = 0.000) and spouse’s approval (χ2 =15.234; df = 1; p = 0.000) were found to be associated with pregnancy timing. On the other hand, child marriages (χ2 =9.305; df = 2; p = 0.010) was found to be associated with pregnancy spacing. The study concluded that a small proportion of study participants had knowledge of healthy timing and spacing of pregnancies and individual and sociocultural factors determined timing and spacing of pregnancies. Therefore, the study recommended that, the Kajiado County health department alongside stakeholders in the field of reproductive health need to address the knowledge gap through up-scaling health education. Furthermore, the department of health needs to collaborate with the children’s and social services departments to address sociocultural determinants like female genital mutilation and child marriages which were still ongoing despite the existing laws that prohibit the practices.