Effects of Pregnancy Risk Level on Birthing Complications in Kenya

Study Context

Maternal and newborn mortality rates remain high in many low- and middle-income countries (LMICs). In 2015, the maternal mortality ratio (MMR) in Kenya was 510 deaths per 100,000 live births, much higher than the rate of 242 deaths per 100,000 live births on average in LMICs. Neonatal mortality rates in Kenya are also high, with an estimated 21 deaths per 1,000 births in 2019 compared to the global average of 17 deaths. High out-of-pocket payments, poor quality health services, limited access to health professionals and obstetric care, and few financial incentives for expectant women and healthcare providers all contribute to these high rates. This study assesses the causal effect of high-risk pregnancy on maternal and newborn complications in Kenya’s Kisumu and Kakamega counties, which face high maternal mortality rates.

Study Design

In this observational study, researchers analyzed the records of 4,419 pregnant women from 16 facilities in Kisumu and Kakamega counties who were enrolled in a mobile health intervention between January 2020 to December 2020. The health intervention includes a financial inclusion program which subsidizes pregnant women’s access to quality healthcare services throughout their pregnancy and postpartum. The research team evaluated how pregnancy risk level assessed at a women’s first antenatal care visit was associated with complications during the pregnancy or during labor and delivery.

Results and Policy Lessons

The double-robust analysis found that women identified as having a high-risk pregnancy at their first antenatal visit had a 23% higher chance of complications during pregnancy and 24% higher chance of complications during labor and delivery.  The study’s results were published in BMJ Open in October 2023 under the title, “Effect of high-risk versus low-risk pregnancy at the first antenatal care visit on the occurrence of complication during pregnancy and labour or delivery in Kenya: a double-robust estimation”.