The determinants of poor maternal health care and adverse pregnancy outcomes in Kenya

The aim of this study is to improve our understanding of factors associated with poor maternal health care and adverse pregnancy outcomes in Kenya. This is achieved by examining factors associated with maternal mortality and poor maternal health care and identifying the direct and indirect pathways of the determinants of unfavourable birth outcomes in Kenya. The findings will help identify the specific elements that should be targeted by the safe motherhood intervention programmes for improved maternal and newborn health.The results from the analysis of maternal mortality show that the probability of a maternal death at the hospitals depends on the women's characteristics as well as the hospitals' effect. The hospitals' effect on the maternal mortality is particularly strong for women with least favourable socio-demographic characteristics, such that this group of women have an extremely high probability of a maternal death if admitted in hospitals associated with high maternal mortality risks. The analysis of maternal health care shows that prenatal and delivery care in Kenya are determined by a wide range of socio-economic and cultural factors relating to the woman or her household; her demographic status and reproductive behaviour relating to a specific pregnancy; and factors relating to availability and accessibility of health services within her community. In addition, maternal health care utilization varies significantly between women and between communities. The analysis of the determinants of unfavourable birth outcomes identified a vast number of potential pathways of the determinants of premature births, small size of the baby at birth and Caesarean section deliveries. The analysis revealed that even though some of the socio-economic and demographic factors such as maternal education, marital status and the desirability of a pregnancy have no direct associations with poor birth outcomes, they have an indirect contribution to these outcomes through intermediate factors such as antenatal care. Antenatal care was identified as a central link between many of the socio-economic and reproductive factors and birth outcomes, hence, an important factor that should rank high in terms of priorities for the safe motherhood intervention programmes.