Maternal health care utilization in Nairobi and Ouagadougou: Evidence from HDSS

Maternal health care utilization in Nairobi and Ouagadougou: Evidence from HDSS

Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi (Kenya) compared to Ouagadougou (Burkina Faso). Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences.

The current study focuses on the obstacles to maternal care utilization in the informal areas of the capital cities of two sub-Saharan African countries, Kenya and Burkina Faso. By comparing the practices of women with similar characteristics in the two cities, the study produces a more nuanced picture of the contextual factors, which promote (or hinder) ANC utilization and skilled delivery among the poor in urban sub-Saharan Africa. 

Following are the key findings of the study:

  • women who shared similar characteristics in the two cities (secondary education, non-poor) have differential maternal health utilization outcomes, with women in Nairobi having a much higher chance of completion of four ANC visits than in Ouagadougou.
  • women in Nairobi may benefit from higher access to for-profit health facilities, which are more common in the Nairobi sites.
  • women in Nairobi may pay special care to ANC because they anticipate delivering at home, and want to make sure their pregnancy offers no signs of complications
  • women need proof of at least one ANC visit to be accepted for a delivery in a hospital in Ouagadougou, but they do not need to complete four visits.
  • women in Ouagadougou are more likely to deliver in hospitals compared with women in Nairobi, on top of the better-known factors (more public health facilities, lower cost, and closer public health facilities).

These results suggest that women are more aware of the importance of ANC utilization in Nairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums in Nairobi may also help women have all four ANC visits. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations.

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