Maternal Health Program Boosts Services in Informal Settlements

Provision and Use of Maternal Health Services among Urban Poor Women in Kenya: What Do We Know and What Can We Do?
Overview
This study examines the maternal health situation in two major Nairobi informal settlements—Korogocho and Viwandani—using both health facility assessments and interviews with 1,927 women. Findings show serious gaps in maternal health services, late antenatal care (ANC), low-quality delivery care, and significant socioeconomic inequalities.
Key Findings
1. Severe shortages in quality obstetric care
Out of 25 facilities used by women in the slums:
17 were inappropriate —small, poorly equipped, often unlicensed.
Only 8 facilities met minimum standards for basic emergency obstetric care (BEOC).
Problems included:
Lack of essential equipment (e.g., anesthetic tools, protective gloves)
Poor physical infrastructure (no piped water, no privacy during delivery)
2. High antenatal care attendance but poor quality and timing
97% of women attended ANC at least once.
But 48% made fewer than the recommended 4 visits (worse than Nairobi overall).
Only 7% initiated ANC in the first trimester—much lower than urban and rural averages.
Late ANC was strongly associated with:
Low household wealth
Low education
High parity
Residence in Korogocho (more disadvantaged)
3. Delivery patterns: many births in facilities, but quality is poor
About 70% delivered in a health facility.
But only 48% delivered in appropriate (minimum standard) facilities.
Wealth, education, and parity strongly influenced use of appropriate facilities.
Korogocho women were more likely to reach appropriate facilities than Viwandani women because of closer physical proximity.
4. Strong link between antenatal care and place of delivery
Women who completed 4+ ANC visits were:
More likely to deliver in an appropriate facility (52%)
Less likely to deliver at home or outside a health facility (25%)
Skipping ANC or doing only 1 visit significantly increased the likelihood of delivering outside a facility.
Conclusions
Nairobi’s urban poor experience worse maternal health outcomes than many rural populations, contradicting the assumption that urban = better health access.
Major barriers include:
Poor quality or absence of nearby services
High cost of transport
Irregular incomes
Poor infrastructure
Overcrowded slum environments
Key recommendation: The Ministry of Health must urgently invest in improving access to quality obstetric services in informal settlements, alongside community-focused health education to encourage ANC uptake and skilled delivery.