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

Abstract

Objectives: This study determined factors associated with the provision and utilization of focused antenatal (FANC) services in Siaya County. It determined challenges faced by health facilities in providing antenatal care, women’s factors associated with uptake of FANC and explored barriers and facilitators to seeking FANC.

Study Design: A cross-sectional design employing mixed methods was conducted among 400 women who had attended antenatal services in eight health facilities in Siaya sub-county following the introduction of free maternal services in these facilities. Women were interviewed retrospectively on services received, timing and number of antenatal visits during pregnancy and challenges to attendance, described using percentages/frequencies. Log-binomial regression model was used to identify socio-demographic factors associated with uptake of FANC. Attendance to ANC four times or more was the outcome variable.

Results: Our findings showed an increase in the uptake of FANC compared to published rates prior to free maternal services. 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.

Conclusion: The findings indicate that when women do not have to pay for antenatal services, their attendance and compliance to the required visits improves. Strategies aimed at optimizing maternal pregnancy outcomes should also invest in providing free maternal services. Other implications of the study are discussed.