High costs undermine Kenya's eight-visit pregnancy care

Kenya remains above its target of fewer than 70 maternal deaths per 100,000 live births by 2030. [Courtesy]

For many pregnant women, completing the recommended eight antenatal care (ANC) contacts is not simply a question of knowing when to visit a health facility. The cost of transport, medical tests, medicines and other services can determine whether a mother returns for her next appointment or drops out of care.

Dr Lillian Otiso, Executive Director of Lvcthealth, says Kenya must address these financial barriers and improve the quality of maternal health services if more women are to complete the eight contacts recommended by the World Health Organisation (WHO).

Drawing from the four-year C-It DU-It project implemented in Homa Bay County, she says community health promoters had helped identify pregnant women early, educate them and link them to health facilities. However, the gains risk being undermined when women arrive at hospitals only to encounter unavailable services or unexpected charges.

The project found that combining community-based and facility contacts could make the eight-contact model more accessible. The proportion of women completing eight facility-based visits rose from about four per cent to approximately 20 per cent, while about 44 per cent achieved a combination of community and facility contacts, compared with 15 per cent in the control group.

But Dr Otiso says the transition from the Linda Mama programme to the Social Health Authority (SHA) initially created uncertainty among pregnant women over registration, eligibility and which facilities could provide covered maternity services.

Although some of the challenges have since been addressed, she explains gaps in coverage remain. Ultrasound scans and some antenatal profile tests, for instance, may still require out-of-pocket payments, depending on the facility.

“When community health workers refer women to hospitals, they expect them to receive services, including consultations and tests. If the tests are unavailable or women are asked to pay for them, they may not return. That limits their ability to complete ANC and eventually have a skilled delivery,” she says.

She warns that encouraging women to attend all eight contacts would have limited impact if facilities lacked essential medicines, laboratory services and adequate health workers. Women who repeatedly make the journey to a hospital but fail to receive the expected services may lose confidence in the health system.

Dr Otiso calls for increased investment in community-based maternal healthcare, arguing that eight visits to a health facility can be difficult for women living in remote areas or those facing financial constraints.

Community health promoters can identify pregnancies early, monitor blood pressure, assess nutritional status, recognise possible complications and refer mothers for specialised care. They can also follow up women already prescribed supplements at facilities, ensuring they continue taking iron tablets and other recommended medication under the supervision of health workers.

To strengthen this arrangement, the project developed a community health assessment and reporting tool known as CHART. It enables community health providers to document household visits, services offered, referrals made and medication follow-ups, allowing facility nurses to monitor their work and provide guidance.

However, she stresses that community-based services should complement, rather than replace, facility care. Health facilities must be equipped to conduct essential tests, screen for conditions such as anaemia and provide timely treatment. This is particularly important because untreated anaemia can increase the risk of complications when a woman experiences excessive bleeding during childbirth.

She also emphasises the need for respectful maternity care, saying women should receive treatment with dignity, privacy and confidentiality, without abuse or discrimination. Poor experiences at health facilities can discourage mothers from returning and contribute to continued preference for traditional birth attendants in some communities.

The need to strengthen maternal healthcare is reflected in Kenya's mortality figures. The 2022 Kenya Demographic and Health Survey placed the maternal mortality ratio at 355 deaths per 100,000 live births. The 2025–26 Kenya Mini Demographic and Health Survey later reported a decline to 263 deaths per 100,000 live births.

Despite the improvement, the country remains above its target of fewer than 70 maternal deaths per 100,000 live births by 2030.

Dr Otiso says achieving that ambition requires more than mobilising women to attend antenatal clinics. It demands sustained investment in community health services, affordable maternal care and well-equipped facilities that can deliver quality services at every contact.

“The priority is to scale up these interventions, but also invest in quality of care at facility level. A woman must be able to access comprehensive services throughout pregnancy, receive respectful treatment and eventually have a skilled delivery,” she says.