Utilization of Eight Antenatal Care Contacts Among Adolescent and Adult Mothers at a Referral Hospital in Western Kenya: A Comparative Cross-Sectional Study
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Introduction
The World Health Organization (WHO) recommends eight antenatal care (ANC) contacts. Kenya adopted this new model in 2022, yet adherence remains low. This study investigated factors influencing the frequency of eight ANC contacts among adolescent and adult mothers in Kenya, using Andersen and Newman’s Behavioural Model for Health Services Utilization.
Methods
We conducted a comparative analytical cross-sectional study at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), Kisumu, Kenya, involving a stratified sample of 73 adolescents and 219 adult mothers. We collected data using a questionnaire and the Mother and Child Health Handbook. We used descriptive statistics, the Mann-Whitney U test, chi-square test and multivariable logistic regression analysis.
Results
Adolescent mothers were less likely to have insurance coverage (74%) compared to adult mothers (90.9%) (p = 0.001) and reported distance to the ANC facility as a barrier (42.5%, p = 0.016). Adherence to eight contacts was low (10.5% for adult mothers and 8.2% for adolescent mothers), with median ANC contacts of 5.00 IQR 3-6 and 4.00 IQR 3-5.5, respectively. Mothers with high-risk pregnancies (AOR = 2.3281, 95% CI: 1.4691-3.9108, p = 0.005) were more likely to complete eight ANC contacts.
Conclusion
The low adherence rates highlight a critical gap in care for non-high-risk pregnancies, whose low compliance appears driven by a reduced perceived need. Health systems must revise antenatal clinical pathways to increase the perceived value of frequent contacts for all mothers and integrate financial support, such as health insurance enrolment, to address economic barriers, especially for adolescents.
