Why antenatal clinic attendance is falling — and the deadly risks for mothers and babies

Many women understand the importance of antenatal care (ANC) once they realise they are pregnant, but attendance in Kenya has dropped sharply in recent years.

A large number of women do not complete even the previously recommended four ANC visits, and many only seek medical care when labour begins.

This delay raises the risk of serious complications for both mothers and newborns, as conditions that could have been detected and treated early often go unnoticed.

Ministry of Health data show that ANC attendance has fallen from about 98 per cent to 62 per cent over the past four years. This decline is linked to rising maternal complications and newborn deaths, as life-threatening conditions such as pre-eclampsia remain undiagnosed.

Although the World Health Organisation (WHO) now recommends at least eight ANC visits, many women in Kenya still struggle to complete even the earlier four-visit schedule. Currently, the country loses an estimated 15 women each day to birth-related complications, along with 92 newborns and 96 stillbirths.

Many women at higher risk

Ruby Machoka, a midwife speaking to The Eastleigh Voice, said irregular ANC attendance places many women at higher risk during childbirth.

“Some mothers only present at health facilities when they are already in labour,” Machoka said, “making it difficult for healthcare providers to access their medical history, which can be dangerous for both mother and baby.”

She also noted that women who have undergone female genital mutilation (FGM) often require specialised care, as they face a higher risk of severe bleeding during delivery.

Anaemia is another major concern. “Many women come to labour with low haemoglobin levels because they did not attend ANC regularly,” Machoka explained.

“Undiagnosed anaemia increases the risk of postpartum haemorrhage, which is one of the leading causes of maternal deaths in Kenya.”

Detect anaemia early

She added that anaemia can also harm the baby, increasing the chances of low birth weight, premature birth and poor recovery after delivery. Through ANC, health workers can detect anaemia early, provide iron and folate supplements, and offer nutrition advice to reduce serious complications during labour.

Machoka observed that while first-time mothers are more likely to follow ANC guidelines, women who have given birth before often assume they already know what to expect. This can be dangerous, as no two pregnancies are the same. Conditions such as diabetes or high blood pressure may develop unnoticed, putting both mother and baby at risk.

“ANC is not just about routine checks,” she said. “Mothers need guidance on nutrition, monitoring for complications, and managing any new health issues. Relying solely on past experience without attending clinics can be extremely dangerous.”

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• Why antenatal clinic attendance is falling — and the deadly risks for mothers and babies
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Sarah Dondi, a nurse and midwife, stressed the wider role of ANC, saying it supports women from the moment they learn they are pregnant until delivery.

“Antenatal care is not just a check-up; it’s a journey that prepares both the mother and baby for a safe delivery,” she said.

ANC is now organised into eight recommended sessions, designed to guide mothers safely through pregnancy and improve outcomes for both mother and child.

Challenges

Dondi explained that ANC and delivery services were previously offered free of charge, which encouraged high attendance. However, challenges such as long distances to health facilities, financial constraints and limited awareness have led many women to miss appointments. This has serious consequences, as women who only arrive at the hospital during labour face higher risks, and healthcare providers may have little or no access to their medical history.

During ANC visits, care is tailored to whether a woman is pregnant for the first time or has given birth before. The first visit is especially detailed, with registration, sample collection, vital signs checks, and measurements of weight and height.

Mothers also receive extensive health education, including how to recognise danger signs and protect their own health and that of their unborn baby.

Dondi highlighted the life-saving role of regular ANC visits. “Through regular clinic visits, we are able to identify life-threatening conditions like pre-eclampsia or severe anaemia before they become emergencies,” she said.

High blood pressure detected early can signal pre-eclampsia, which may progress to eclampsia and lead to the death of the mother or baby if untreated. Anaemia can also be identified and treated before labour. Women with conditions such as diabetes, teenage pregnancies or other high-risk factors are often referred for specialised care.

Skipping ANC increases the risk of serious complications. Undetected problems such as low haemoglobin levels, multiple pregnancies or underweight babies can lead to poor outcomes.

Postpartum haemorrhage

Anaemia alone is a major contributor to postpartum haemorrhage, one of the leading causes of maternal and newborn deaths in Kenya.

To reduce maternal and infant deaths, Dondi urged women to fully embrace ANC, follow medical advice and take prescribed treatments.

“Pregnant women should always plan to give birth in hospitals where skilled birth attendants are available, and complete all eight recommended ANC visits to safeguard both their lives and their baby’s,” she advised.

Antenatal care remains a cornerstone of maternal healthcare. Regular clinic visits, following medical guidance and early detection of conditions such as anaemia and pre-eclampsia can greatly reduce deaths, improve pregnancy outcomes and ensure safer deliveries. ANC is more than routine check-ups — it is a lifeline for mothers and their babies.

National data on ANC and maternal and newborn health show both progress and ongoing gaps. About 66 per cent of women attend the fourth ANC visit, but only 4 per cent complete the recommended eight or more visits. National targets aim to raise coverage to 70 per cent for the fourth visit and 30 per cent for eight or more visits.

Neonatal mortality remains a concern, with 21 deaths per 1,000 live births nationally and 36.3 per 1,000 in health facilities, although facility-based figures have improved to 22.3 per 1,000.

Maternal mortality is also high, with a national ratio of 355 deaths per 100,000 live births, compared with 103 per 100,000 in health facilities.

Stillbirth rate

Other indicators show a stillbirth rate of 23 per 1,000 births, perinatal mortality of 13.2 per cent, skilled birth attendance at 89 per cent and postnatal care coverage at 72 per cent. Improving ANC attendance and ensuring skilled care at birth could significantly reduce these numbers.

The leading direct causes of preventable maternal deaths include postpartum haemorrhage, eclampsia, sepsis, abortion-related complications and other obstetric emergencies. Postpartum haemorrhage accounts for 37 per cent of direct maternal deaths, eclampsia 22 per cent and sepsis 12 per cent.

Indirect causes also contribute heavily to maternal deaths. Anaemia is the most significant, responsible for 60 per cent of indirect maternal deaths. Cardiovascular diseases and HIV/AIDS each account for 19 per cent, with HIV-related deaths varying by county.

Malaria contributes 7 per cent, particularly in coastal and lakeside regions. Additional risks include adolescent pregnancies and high-parity pregnancies in women over 35, both of which increase the likelihood of complications.

The WHO recommends that all pregnant women have at least eight contacts with healthcare providers during pregnancy. This approach replaces the older four-visit model, as evidence shows that more frequent contact improves early detection and management of risks for both mother and baby.

The first ANC contact should take place within the first 12 weeks of pregnancy, with later visits spaced to monitor health more closely as risks increase.

During ANC visits, women receive essential services such as blood pressure checks, urine tests, early ultrasounds, nutritional support including iron and folic acid supplements, infection prevention and treatment, and guidance on healthy practices, danger signs and birth preparation. The aim is to support both physical and mental well-being throughout pregnancy.