Waiting too long: low use of maternal health services in Kalabo, Zambia

OBJECTIVE To determine the level of use of maternal health services and to identify and assess factors that influence women's choices where to deliver in Kalabo District, Zambia. METHODS A cross-sectional descriptive study conducted between 1998 and 2000, with 332 women interviewed using semi-structured questionnaires. Focus group discussions were held and hospital data and registers were checked. RESULTS Although 96% of respondents would prefer to deliver in a clinic, only 54% actually did, because of long distances, lack of transport, user fees, lack of adequate health education given during antenatal clinic attendances, poorly staffed and ill-equipped institutions with poorly skilled personnel. CONCLUSION Unmarried women, women with higher education and women with formal employment, who are able to pay the user fees and live near a clinic are more likely to deliver in a clinic. This does not guarantee survival, however; maternal mortality is high in the district; health facilities are poorly staffed, poorly skilled and ill-equipped.