Determinants of quality antenatal care use in Kenya: Insights from the 2022 Kenya Demographic and Health Survey

Provision of quality antenatal care (ANC) is important to reduce maternal and newborn fatalities worldwide. However, the use of quality ANC by women of reproductive age and associated factors remain unclear in many developing countries. Therefore, this study aimed to determine factors associated with receiving quality ANC in Kenya among women of reproductive age. We analyzed secondary data from the 2022 Kenya Demographic Health Survey, which included 11,863 women. Participants were selected using two-stage stratified sampling. Univariate and multivariable logistic regression analyses were used to analyze the data. Of the 11,863 participating women, 61.2% (95% confidence interval (CI): 59.7%-62.6%) received quality ANC. Participants aged 20-34 years had a 1.82 (95%CI: 1.15-2.87) times higher likelihood of receiving quality ANC compared with those aged 15-19 years. Those who had attended four or more ANC visits were 1.42 (95%CI: 1.14-1.79) times more likely to receive quality ANC than those who attended three or fewer visits. Participants with media access were 1.47 (95%CI: 1.06-2.03) times more likely to receive quality ANC than those without media access. Compared with participants in the "poorest" quintile, the likelihood of receiving quality ANC was 1.93 (95%CI: 1.21-3.08) and 1.44 (95%CI: 1.01-2.06) times higher for participants in the "richest" and "richer" quintiles, respectively. Furthermore, compared with participants from the Coastal region, the odds of receiving quality ANC were 0.25 (95%CI: 0.15-0.31) to 0.64 (95%CI: 0.44-0.92) times lower for those from all other Kenyan regions. Participants whose partners made their healthcare decisions were 0.74 (95%CI: 0.58-0.95) times less likely to receive quality ANC than those who made decisions independently. We found that just over 60% of participating mothers had received quality ANC. Factors associated with receiving quality ANC were: age, region, maternal education, healthcare-seeking decision-making, access to media, time to the health facility, ANC visits, and ANC provider type (doctor, nurse/midwife/clinical officer). Maternal health improvement programs should prioritize promoting access to education for girls. Furthermore, interventions should focus on promoting shared decision-making and autonomy in healthcare-seeking behaviors among pregnant women and their partners, increasing access to care provided by skilled healthcare workers, and addressing regional disparities in healthcare delivery.