Abstract:
Background: The majority of maternal deaths, stillbirths, and neonatal deaths are concentrated in a few countries, many
of which have weak health systems, poor access to health services, and low coverage of key health interventions. Early
and consistent antenatal care (ANC) attendance could significantly reduce maternal and neonatal morbidity and mortality.
Despite this, most Kenyan mothers initiate ANC care late in pregnancy and attend fewer than the recommended visits.
Methods: We used survey data from 6,200 pregnant women across six districts in western Kenya to understand
demand-side factors related to use of ANC. Bayesian multi-level models were developed to explore the relative
importance of individual, household and village-level factors in relation to ANC use.
Results: There is significant spatial autocorrelation of ANC attendance in three of the six districts and considerable
heterogeneity in factors related to ANC use between districts. Working outside the home limited ANC attendance.
Maternal age, the number of small children in the household, and ownership of livestock were important in some
districts, but not all. Village proportions of pregnancy in women of child-bearing age was significantly correlated to ANC
use in three of the six districts. Geographic distance to health facilities and the type of nearest facility was not correlated
with ANC use. After incorporating individual, household and village-level covariates, no residual spatial autocorrelation
remained in the outcome.
Conclusions: ANC attendance was consistently low across all the districts, but factors related to poor attendance varied.
This heterogeneity is expected for an outcome that is highly influenced by socio-cultural values and local context.
Interventions to improve use of ANC must be tailored to local context and should include explicit approaches to
reach women who work outside the home.
