Gaps in quality, person-centered prenatal care in rural Kenya

Maternal and neonatal mortality have remained high in low-resource settings despite recent progress. High quality prenatal care can address this by preventing or identifying complications or pre-existing conditions early in pregnancy. It can also make it more likely that women will go to a facility for skilled care during birth. Kenya’s national guidelines recommend 4 comprehensive and targeted visits, but also urge providers to treat each visit as though it may be the only one. The guidelines say, “Antenatal care should be simpler, safer, friendly and more accessible. Women are more likely to seek and return for services if they feel cared for and respected by their providers.”

New Bixby research looks at the quality of care through surveying women in Migori County, a rural county in western Kenya. It’s one of few studies to look at both provision of prenatal services and women’s experiences of care.

They found that the level of care was below where it should be in both providing the recommended prenatal care services and ensuring that women have a good experience. While many women received basic services like blood pressure monitoring and urine tests at least once during pregnancy, they are not receiving them consistently at every visit as recommended in the guidelines. The situation is even more dire for advanced services like ultrasounds, which fewer than 1 in 5 women received. Women with complications were not more likely to receive an ultrasound.

In terms of providing patient-centered care, the major gap was in communications. Women were not given sufficient information about their care, so they don’t understand the purpose of exams and medicines but aren’t given the opportunity to ask questions. Most women felt respected by providers, an encouraging result, but the fact that 1 in 10 didn’t feel that way shows that there is still room for improvement.

As in many areas of health care, the most disadvantaged and disempowered women received the lowest quality care, both in terms of services provided and their experience of care. Potential reasons that some women get better treatment could include being able to access facilities that offer higher quality care, being able to pay for higher quality care and having the knowledge and ability to advocate for better care.

There are reasons related to structural factors and provider attitudes that could account for the low quality of care. Providers aren’t able to take weight and blood pressure measures or do blood and urine tests if they don’t have the right equipment and laboratories. They can’t give out medication if it’s not in stock. The availability of the necessary equipment and supplies are key to providing good prenatal care. Those structural factors could also impact person-centered care if they manifest as frustration in providers’ interactions with women. A lack of provider knowledge of guidelines and lack of willingness to provide person-centered care could also account for the poor quality. Poor communication could be because of time constraints—it takes less time to just provide services than to answer questions. But that means that women might not adhere to treatment and recommendations for further tests because they don’t understand why they’re important.

A lot of work remains to improve both dimensions of quality prenatal care. While it’s important to get women to health facilities, much more is needed to achieve the benefits of prenatal care by ensuring women consistently receive services. The momentum behind improving person-centered care during childbirth should spread to prenatal care. As countries like Kenya update their national guidelines, they must consider how to strengthen providers to provide person-center care to all women in all types of facilities.