Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007–2013

Abstract

Setting: A rural private health facility, Ruby Medical Cen tre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya. Objectives: Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete ante natal care (ANC) package and associated factors. Design: Retrospective cross-sectional study using routine programme data. Results: During the study period, 2635 women delivered at the RMC: 50% were aged 16–24 years, 60% trans ferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the teta nus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC else where were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births. Conclusion: This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, in creased efforts should be made to ensure earlier presen tation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions