Birthing Choices Made by Pregnant Women on Mageta Island, Western Kenya.

BACKGROUND: Birthing choices play significant roles in maternal outcomes. This article describes the birthing choices made by some women on Mageta Island (hereafter called simply "the Island") of Western Kenya in relation to Universal Health Coverage (UHC) and free maternity services (FMS) policy ideals. Kenya has officially rolled out UHC and has also initiated universal coverage of maternal healthcare services to reduce maternal morbidities and mortalities. In 2016, the government of Kenya expanded FMS, called the Linda Mama (Taking Care of the Mother) initiative, which targets all pregnant women, newborns, and infants by offering free maternal healthcare services. Despite the existence of UHC and FMS in Kenya, women living on the Island have no access to such services. They therefore devise mechanisms for accessing maternal healthcare services. DESIGN: This study is based on an ethnographic design. Data were collected for 5 months using informal conversations, participant observation, and note-taking with mothers at their homes. The study included interviews with six pregnant mothers who were living on the Island at the time of our interviews. DISCUSSION: It emerged that women relied on their agency to find alternatives to biomedical maternal healthcare services, despite the existence of UHC. Such alternatives included having traditional midwives attend their births in their own homes, migrating to the mainland for proper care, and using kin relations as alternatives for birthing beyond the Island. This article highlights how the implementation of the UHC policy might be tailored to specific local contexts, which could help avert maternal mortalities in hard-to-reach areas such as the Island.