Is there a fast track to better pregnancy outcomes in Kenya?

Socioeconomic and cultural factors affect pregnancy outcomes through a range of intermediary factors. Researchers from the UK University of Southampton trace the direct and indirect series of factors leading to poor birth outcomes in Kenya. Antenatal care is a common link and should be the focus of maternal health policy, they conclude.

Many Kenyan women endure a lifetime of poor health and malnutrition as a direct result of social, cultural, political and economic factors. Pregnant women are particularly vulnerable to adverse outcomes, both for themselves and for their babies. Poor pregnancy outcome is the result of complex interactions between socioeconomic and cultural factors, reproductive behaviour, health care use, maternal health and other biological factors.

The researchers used data from the 1993 Kenya Demographic and Health Survey on 6 115 births to 3 929 women to look at factors leading to premature birth, small babies and Caesarean section delivery. They found that:

• All of the socio-demographic factors considered in the analysis are inter-related, apart from maternal age and household socioeconomic status. So there are many potential pathways of the factors leading to poor birth outcomes.
• Reproductive factors, such as marital status and whether a pregnancy is wanted, have no direct association with adverse outcomes. However, they are indirectly linked to birth outcomes through antenatal care.
• Socioeconomic factors, such as maternal education, urban/rural residence and socioeconomic status have an indirect link to premature delivery through other factors, particularly antenatal care and access to maternal health services.

Antenatal care links many socioeconomic and reproductive factors with poor birth outcomes. The researchers conclude that safe motherhood programmes in Kenya should:

• prioritise appropriate antenatal care, with respect to both timing and frequency of visits
• target subgroups that often miss out on adequate care, such as women with unplanned pregnancies, single mothers, women of low socioeconomic status and rural women
• increase physical access to antenatal care, as use of these services depends on the journey time involved
• concentrate their limited resources on the most cost-effective aspects of antenatal care.

Source(s):
‘Pathways of the determinants of unfavourable birth outcomes in Kenya’, Journal of Biosocial Science 36: 153-176, by M. Magadi et al, 2004
'The inequality of maternal health in urban sub-Saharan Africa', Population Studies 57(3): 349-368, by M. Magadi, E. Zulu and M. Brockerhoff, 2003
'Factors associated with unfavourable birth outcomes in Kenya', Journal of Biosocial Science 33(2): 199-225, by M. Magadi, I. Diamond and N. Madise, 2001

id21 Research Highlight: 9 November 2004

Further Information:
Monica Magadi
Centre for Research in Social Policy (CRSP)
Department of Social Sciences
Loughborough University
Leicestershire
LE11 3TU
UK

Tel: +44 (0) 1509 223392
Fax: +44 (0) 1509 213409
Contact the contributor: m.a.magadi@lboro.ac.uk

University of Southampton, UK

Other related links:
'Targeting the causes of perinatal mortality in a Kenyan hospital'

'Motherhood in the city: poor urban women and maternal health care provision in sub-Saharan Africa'

'The unhappy event: the risk of poor birth outcomes in Kenya'

'Antenatal care reborn? Healthcare for pregnant women in developing countries'

'Dicing with death? The impact of hospital choice and other factors on maternal mortality'

See id21's collection of links relevant to maternal and child health.