Abstract:
Abstract
Introduction: In Kenya, the maternal mortality rate had ranged from 328 to 501 deaths per 100,000 live births over
the last three decades. To reduce these rates, the government launched in 2006 a means-tested reproductive health
output-based approach (OBA) voucher program that covers costs of antenatal care, a facility-based delivery (FBD)
and a postnatal visit in prequalified healthcare facilities. This paper investigated whether women who bought the
voucher for their index child and had a FBD were more likely to deliver a subsequent child in a facility compared to
those who did not buy vouchers.
Methods and Findings: We used population-based cohort data from two Nairobi slums where the voucher program
was piloted. We selected mothers of at least two children born between 2006 and 2012 and divided the mothers into
two groups: Index-OBA mothers bought the voucher for the index child (N=352), and non-OBA mothers did not buy
the voucher during the study period (N=514). The most complete model indicated that the adjusted odds-ratio of FBD
of subsequent child when the index child was born in a facility was 3.89 (p<0.05) and 4.73 (p<0.01) in Group 2.
Discussion and Conclusion: The study indicated that the voucher program improved poor women access to FBD.
Furthermore, the FBD of an index child appeared to have a persistent effect, as a subsequent child of the same
mother was more likely to be born in a facility as well. While women who purchased the voucher have higher odds of
delivering their subsequent child in a facility, those odds were smaller than those of the women who did not buy the
voucher. However, women who did not buy the voucher were less likely to deliver in a good healthcare facility,
negating their possible benefit of facility-based deliveries. Pathways to improve access to FBD to all near poor
women are needed.
