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

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Abstract
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. 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. 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. 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.