Multiple studies conducted around the world have observed that poorer women tend to receive poorer quality of maternal health care. In Kenya, the wealthiest women are four times as likely to deliver in a health facility and with a skilled birth attendant. Many of the health facilities in Kenya function without basic infrastructure, such as electricity and clean water, and most do not have the capacity to perform cesarean section surgeries. While it is clear that many facilities in Kenya and other low-income countries lack essential resources, the evidence examining the quality of clinical processes throughout the continuum of maternity care remains limited.
A recent study from the MHTF-PLOS Collection, “Neglected Populations: Decreasing Inequalities & Improving Measurement in Maternal Health” published by Sharma and colleagues assessed the quality of maternal health services in Kenyan facilities and the relationship between quality of care and poverty. In order to estimate levels of poverty in various areas, the researchers took into account multiple indicators related to education, health, standard of living and household wealth. Using mixed methods—direct observation, facility audit data analysis and provider interviews—the authors then measured three aspects of high quality maternal health care in 550 facilities.
Examples of indicators measured:
|
Infrastructure |
Antenatal care |
Delivery care |
| Clean water supply | Assessment of client history | Blood pressure test |
| Electricity | Counseling on danger signs during pregnancy | Handwashing before examinations |
| Trained 24-hour staff | Counseling on delivery location | Timely administration of uterotonic |
| Equipment and supplies | Administration of tetanus toxoid injection | Placenta examination |
| Medicines | HIV test | Breastfeeding initiation within one hour |
Overall, quality of maternal health care was low, especially for adequate antenatal and delivery care. At the county level, only 9% of the Kenyan population had effective antenatal care (ANC) coverage and only 17% had effective delivery care coverage. These findings are consistent with previous studies conducted in Ghana, Malawi and Zambia. Infrastructure tended to be consistently fair across facilities, but many lacked essential supplies such as towels, magnesium sulfate and exam lights.
The quality of maternal health care was significantly worse for poorer women. On average, women living in the most impoverished areas of Kenya received one third of basic clinical ANC compared to wealthier women, who received roughly 60% of basic ANC. Similarly, only 8% of impoverished women had access to adequate delivery care compared to 24% of wealthier women.
Inequities in maternal health care quality lead to inequities in maternal and newborn health outcomes, as illustrated by the fact that the poorest counties in Kenya have the highest maternal mortality ratios in the country. Ensuring that women receive high quality services across the continuum of care—regardless of their socioeconomic status—is essential for ending preventable maternal and newborn deaths and reducing inequities.
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Access other papers from the MHTF-PLOS collection, “Neglected Populations: Decreasing Inequalities & Improving Measurement in Maternal Health.”
Learn more about quality of maternal health care.
Read diverse perspectives on maternal health care quality in the MHTF blog series.