Globally, a woman dies every minute from complications related to childbirth . About half a million women die each year due to maternal causes with 99% of the deaths taking place in developing countries [1, 2]. The challenge of reducing maternal mortality remains a major problem in Kenya. The 2003 Kenya Demographic and Health Survey (KDHS) estimated maternal mortality ratio (MMR) at 444/100,000 live-births. Other estimates put the ratio at 1,000/100,000 live births, representing a 1 in 25 lifetime risk of dying from a maternal-related cause [3, 4]. Use of maternal health services is an effective approach to reducing the risk of maternal morbidity and mortality, especially in places where the general health status of women is poor [5–8]. Attending antenatal clinics and delivery with the assistance of skilled professionals (doctors and nurses) can lead to marked reductions in maternal morbidity and mortality through early detection and management of potential complications [5, 6, 9, 10]. According to the World Health Organization (WHO), a maternal mortality is defined as the death of a woman while pregnant or within 42 days after the termination of a pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental causes [11, 12].
Data from the Kenya Demographic and Health Survey (KDHS) show that although the overall ANC coverage remains high, many women make their first ANC visit late in pregnancy . Importantly too, use of skilled professionals during delivery declined from 50% in 1989 to 42% in 2003, further demonstrating a deterioration in the use of maternal health services among women . Key interventions through the Safe Motherhood initiative, the International Conference on Population and Development (ICPD) of 1994 and the 5th Millennium Development Goal (MDG 5) have been adopted by the international community to improve maternal health by ensuring access to quality services in order to detect and manage life-threatening complications and reduce maternal morbidity and mortality [13–16].
According to the 2009 Kenya Preliminary Census report, young people (ages 15-24) who form about 36% of the total population, are the fastest growing segment of the population . The young people face challenges of unemployment, early initiation into sex, abortions, unwanted pregnancies, and sexually transmitted diseases including HIV/AIDS among others . For example, about 20% of the young women were either pregnant or had a birth at the time of the Kenya Demographic and Health Survey of 2003 . Like many other health indicators, the burden of maternal morbidity and mortality is higher among this group as the risk of developing serious complications and subsequent death during pregnancy and childbirth are higher for them . Furthermore, cultural and religious biases also discourage them from seeking reproductive health services, while some health providers are reluctant to provide contraceptives, to unmarried young women .
Many health providers have little training and experience in meeting special reproductive health needs of the young women and are ill equipped to solve their problems. This has contributed to a reduction in the use of maternal health services by the young women . In addition, some married young women are disadvantaged in terms of decision making. For example, some have to consult their husbands and mothers-in-law before seeking maternal health care. These young women end up missing out on services geared towards adolescents because of their marital status, and are also denied services targeted towards married women because of their relatively young age, as well as lack of experience and autonomy [20–23].
Several studies have looked at the use of antenatal and delivery services, with a focus on the needs of women in the reproductive age [24–26]. This study is unique in that it focuses on timing of first ANC visit and type of delivery assistance sought by young women. Although frequency and timing of ANC visits are both important for timely identification and mitigation of potential pregnancy complications, this study only focused on timing of the first antenatal visit. This is because countrywide statistics indicate that use of antenatal care services in general is high, while initiation of antenatal visits is often delayed . It is evident that the universally free ANC coverage in Kenya does not fully translate into use of skilled assistance since only 42% of births to all women are assisted by skilled professionals at the time of delivery. This study sought to investigate the association between the timing of young women's first ANC visit and their use of skilled professionals at delivery. The study results should contribute to our understanding of utilization of maternal health services and its associated determinants among the young women in Kenya. It is envisaged that a promptly executed first ANC visit would allow time for more such visits during the pregnancy, thereby enabling the woman to learn more about potential complications of pregnancy and the benefits that can be gained from professional delivery assistance. Such women are, therefore, better placed to seek professional assistance at delivery, hence the hypothesis that timely first ANC visit would be positively associated with professional delivery assistance.
The objectives of this study were;
To determine the linkage between timing of the first ANC visit and delivery assistance
To establish the determinants of timing of first ANC visit and delivery assistance