American Journal of Public Health Research
ISSN (Print): 2327-669X ISSN (Online): 2327-6703 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Public Health Research. 2014, 2(4), 153-158
DOI: 10.12691/ajphr-2-4-5
Open AccessArticle

Maternal Autonomy, Distance to Health Care Facility and ANC Attendance: Findings from Madiany Division of Siaya County, Kenya

C.O. Asweto1, 2, , J.R. Aluoch1, C.O. Obonyo3 and J.O. Ouma4

1School of Public Health and Community Development, Maseno University, Kisumu, Kenya

2Faculty of Health Science, Great Lakes University of Kisumu, Kisumu, Kenya

3Kenya Medical Research Institute (KEMRI), Kisumu, Kenya

4Public Health Department, University of Kabianga, Kabianga, Kenya

Pub. Date: August 11, 2014

Cite this paper:
C.O. Asweto, J.R. Aluoch, C.O. Obonyo and J.O. Ouma. Maternal Autonomy, Distance to Health Care Facility and ANC Attendance: Findings from Madiany Division of Siaya County, Kenya. American Journal of Public Health Research. 2014; 2(4):153-158. doi: 10.12691/ajphr-2-4-5


Half a million women die annually from pregnancy related causes. In Kenya, maternal mortality ratio (MMR) remains high in spite of great efforts to improve maternal health care. We studied some factors linked to maternity in a rural community setting. A survey was conducted in the community living in Madiany division of Siaya County, Kenya. We randomly sampled 403 mothers of children under three years old. Variables of interest were antenatal care attendance (ANC), parity, distance from the health facility and women empowerment (autonomy). Nearly 94% of the mothers had at least one ANC visit and 48.6% had completed the recommended four or more ANC visits; about 65.7% initiated ANC at first trimester. Parity, distance to the health facility and autonomy were associated with ANC visits. Mothers with one child had a twice higher chance of at least four ANC visits than those with more than one child. Those living at most 60 minutes travel-time from the health facility were seven times more likely have early ANC initiation and five times more likely to have at least four ANC attendance than those living more than 60 minutes travel-time from the health facility. Autonomy was linked to early initiation of ANC visit. This may indicate that improving maternal care and achieving Millennium Development Goal (MDG) 5 target, it is important to improve coverage of health facilities and implement development programs that empower rural women.

antenatal care maternal mortality ratio autonomy

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  WHO and UNICEF. (2003). Antenatal care in developing countries. Promises, achievements and missed opportunities, An analysis of trends, levels and differentials, 1990-2001. Geneva: World Health Organization.
[2]  WHO, UNICEF, UNFPA and World-Bank. (2007). Maternal Mortality in 2005: Estimates developed by estimates developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva: World Health Organization.
[3]  MOH. (2006). Health service availability and utilization. Retrieved 22 January, 2011. from
[4]  KNBS. (2010). Kenya Demorgraphic Health Survey 2008/2009.
[5]  WHO. (2001). Women's health in South-East Asia: Women Health profile factors determining women's health.: WHO regional office for south east Asia.
[6]  van Eijk, A. M., Bles, H. M., Odhiambo, F., Ayisi, J. G., Blockland, I. E., Rosen, D. H., Adazu, K., Slusker, L. and Lindblade, K. A. (2006). Use of antenatal services and delivery care among women in rural western Kenya. Reproductive Health, 3(2).
[7]  RDDP. (2009). Rarieda District Development Plan.
[8]  Amooti-Kaguna, B. and Nuwaha. (2000). Factors influencing choice of delivery sites in Rakai district of Uganda, Social Science and Medicine, 50, 203-213.
[9]  Erlindawati, Chompikul, J. and Isaranurug, S. (2008). Factors related to the utilization of antenatal care services among women at Aceh Darussalam Province, Indonesia. Journal of Public Health Development, 6, 99-108.
[10]  Kenthongkham, K. (2007). Knowledge, Attitude and Antenatal Care Practices of Women at Ad Distict, Huaphane Province, Laos. Health Service System Management, 53:45-63.
[11]  Yang, Y., Yoshidal, Y., Rashid, H. and Sakamoto, J. (2010). Factors Affecting the Utilization of Antenatal Care Services Among Women in Kham District, Xiengkhouang Province. Journal of Medical Science, 72, 23-33.
[12]  UNFPA. (2004a). State of the World's Population. The Cairo Consensus at Ten: Population, Reproductive Health and the Global Effort to End Poverty, 2004. New York: United Nations Population Fund.
[13]  Celik, Y. and Hotchkiss, D. R. (2000). The socioeconomic determinants of maternal health care utilization in Turkey. Social Science Medicine, 50(12), 1797-1806.
[14]  Magadi, M. A., Madise, N. J. and Rodrigues, R. N. (2000). Frequency and timing of antenatal care in Kenya: Explaining the variation between women of different communities. Social Science and Medicine, 51(4), 551-561.
[15]  Sharma, S. K., Sawangdee Y. and Sirirassamee B. (2007). Access to health: women's status and utilization of maternal health services in Nepal. Journal of Biosocial Science, 39, 671-692.
[16]  Bloom, S. S., Wypij, D. and Gupta, M. D. (2001). Dimension of women autonomy and influence on maternal health care utilization in North India City.
[17]  Ngula, A. K. (2005). Women's perception on the under utilization of intrapartum care services in Okakarara district, Namibia., University of Cape Town.
[18]  Chakraborty, N., Islam, M. A., Chowdbury, R. I. W. and Akhter, H. H. (2003). Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International, 18(4), 327-337.
[19]  Fotso, J. C., Ochako, R. A. and Ezeh, A. (2006). Interplay between women's percieved quality of, and access to care and household wealth on the utilization of maternity services among the urban poor.
[20]  ILO. (2003). Statistic of Employment, Unemployment, Under-employment: Economically Active Population, [Electronic Version]. Retrieved 23rd June, 2011
[21]  Swenson I. E., Thang N. M., Nahn V. O. and Tieu P. X. (1993). Factors related to the utilization of prenatal care in Vietnam. Journal of Tropical Medicine and Hygiene, 96(2), 76-85.
[22]  McDonagh M. (1996). Is antenatal care effective in reducing maternal morbidity and mortality? Health Policy and Planning, 11(1), 1-15.
[23]  UNFPA (2004b). Maternal mortality updates: Delivering in to good hands. New York: United Nations Population Fund.