Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya

Mardieh L. Dennis, Lenka Benova, Timothy Abuya, Matteo Quartagno, Ben Bellows, Oona M. R. Campbell

Research output: Contribution to journalA1: Web of Science-article


This study explores the relationship between two health financing initiatives on women's progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006-16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48h of delivery). Full implementation of the voucher programme was positively associated with receiving continuous care among users of 1+ ANC [interaction term adjusted odds ratio (aOR): 1.33, P=0.014]. Early ANC initiation (aOR: 1.32, P=0.001) and use of private sector ANC (aOR: 1.93, P

Original languageEnglish
JournalHealth Policy and Planning
Issue number2
Pages (from-to)120-131
Number of pages12
Publication statusPublished - 2019


  • Continuity of Patient Care/statistics & numerical data
  • Cross-Sectional Studies
  • Delivery, Obstetric/economics
  • Female
  • Humans
  • Insurance, Health/statistics & numerical data
  • Kenya
  • Maternal Health Services/economics
  • Parity
  • Postnatal Care/economics
  • Pregnancy
  • Prenatal Care/economics
  • Socioeconomic Factors
  • Surveys and Questionnaires

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