Removing user fees and providing knowledge can improve utilization of FANC services, findings from a cross-sectional study in rural Kenya

Abstract BackgroundFocused antenatal care was recommended by the World Health Organization to mitigate negative pregnancy and birth outcomes. It requires that a woman seeks medical care at least four times in the course of her pregnancy if there are no complications. However, in the low income settings, women are not able to attend ANC early and for all the schedules because of the costs involved including medical fees. In 2017, Kenya included antenatal care in the package of free maternal services provided by the government. We aimed to examine the uptake of free antenatal care (FANC) services by women in a rural community.MethodsA cross-sectional design employing mixed methods was conducted among 400 pregnant women who attended antenatal services in eight health facilities in Siaya sub-county following the introduction of FANC in these facilities. The women were interviewed on services received the timing of these antenatal visits, the number of visits in the course of the pregnancy and the challenges to attending antenatal services. Participants’ characteristics were described using means and proportions. Uptake of FANC defined by the number of women who sought FANC, the timing of the visits and how frequently they attended was described using percentages/frequencies. Log-binomial regression model was used to identify socio-demographic factors associated with uptake of FANC among the women. In this analysis, attendance to ANC four times or more was the outcome variable.ResultsOur findings showed an increase in the uptake of FANC compared to published rates of uptake. Overall, 76.4% (n=400) of the women reported attending ANC four times or more. Over half (61.7%), of the women had their first ANC visit in the second and third trimester. Women who were not married were 1.5 times (PR=1.50; CI=1.16-1.93) more likely to complete 4+ FANC visits when compared to women who were married. Women who attended ANC for the first time in their second and third trimester were 41% (PR=0.59; CI=0.49-0.72) and 90% (PR=0.10; CI=0.03-0.37) respectively, less likely to complete the 4+ FANC visits, when compared to those who started ANC in the first trimester.Conclusion The findings indicate that when women do not have to pay for antenatal services, their attendance and compliance to the scheduled visits improves. Therefore, strategies aimed at optimizing maternal pregnancy outcomes should also invest in providing free maternal services. Other implications of the study are discussed.