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This study is a theory-driven analysis of the socio-demographic determinants of maternal care seeking in Kenya. Specifically, it examines predisposing, enabling, and need factors potentially associated with use of antenatal care (ANC), health facility delivery, and timely postnatal care (PNC).
This study uses data from the 2014 Kenya Demographic and Health Survey (KDHS) conducted among women age 15-49 with a live birth in the five years preceding the survey. It includes data from all 47 counties of Kenya, grouped contiguously into 12 regions. We apply Andersen’s Behavioral Model of Health Services Use to examine socio-demographic predictors of health service use. We estimate logistic regression models for adequate use of ANC (defined as attending at least four ANC visits, starting in the first three months of pregnancy), delivery in a health facility, and PNC within 48 hours of delivery.
The odds of adequate ANC are significantly higher for women with a secondary or higher level of education, women in the richer and richest wealth quintiles, and women with low parity. Compared with the Nairobi region, women in the Mid Rift region and Nyanza North region have significantly higher odds of obtaining adequate ANC.
Delivery in a health facility is significantly more common among women with secondary or higher education, women in the richest wealth quintile, women in urban areas, women with only one child, women having no fertility risk, and women who received adequate ANC. Compared with the Nairobi region, women’s odds of delivery in a facility are higher in the Central region and Upper Eastern region. Significantly lower odds are found in the Lower Eastern, Upper Rift, Mid Rift, and Western regions.
Receiving timely PNC—within 48 hours of delivery—is significantly associated with women’s level of education. Similarly, women in the richest wealth quintile have higher odds of receiving timely PNC. Compared with the Nairobi region, only Upper Eastern region and Nyanza North region have significantly higher odds for PNC within 48 hours. Three other regions have significantly lower odds compared with Nairobi: the North Eastern, Upper Rift, and Western regions. Primiparous women have higher odds of timely PNC than women with two or more children. Higher odds of PNC are also found among women with no fertility risk compared with those with fertility risk. Women who received at least four ANC visits and women who delivered at a health facility also are significantly more likely to receive PNC in the 48 hours after childbirth.
A common set of factors examined in the study is associated with use of ANC, health facility delivery, and timely PNC. These include women’s education (predisposing factor), wealth quintile and region (enabling factors), and parity and fertility risk (need factors). Results also suggest that need factors, including experience with prior stages of care, are more prominent than predisposing and enabling factors in their influence on maternal care-seeking behavior.