Use of antenatal services and de livery care among women in rural western Kenya: a community based survey

Abstract

Background: Improving maternal health is one of th e UN Millennium Development Goals. We assessed provision and use of an tenatal services and delivery care among women in rural Kenya to determine whether women were receiving appropriate care. Methods: Population-based cross-sectional survey among women who had recently delivered. Results: Of 635 participants, 90% visited the antenatal clinic (ANC) at least once during their last pregnancy (median number of visits 4). Most wo men (64%) first visited the ANC in the third trimester; a perceived lack of qua lity in the ANC was associated wi th a late first ANC visit (Odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0–2.4). Wome n who did not visit an ANC were more likely to have < 8 years of education (adjusted OR [AOR] 3.0, 95% CI 1.5–6.0), and a low socio-economic status (SES) (AOR 2.8, 95% CI 1.5–5.3). The ANC provision of abdominal palpation, tetanus vaccination and weight measur ement were high (>90%), but provision of other services was low, e.g. malaria pr evention (21%), iron (53%) an d folate (44%) supplementation, syphilis testing (19.4%) and health talks (14.4%). Eighty percent of women delivered outside a health facility; among these, traditiona l birth attendants assisted 42%, laypersons assisted 36%, while 22% received no assistance. Factors si gnificantly associated with giving birth outside a health facility included: age ≥ 30 years, parity ≥ 5, low SES, < 8 years of education, and > 1 hour walking distance from the health facility. Wome n who delivered unassisted were more likely to be of parity ≥ 5 (AOR 5.7, 95% CI 2.8–11.6)