Socioeconomic and sociodemographic inequalities in the continuum of maternal healthcare utilization in Kenya: Evidence from the 2022 Kenya Demographic and Health Survey

Abstract Background The continuum of maternal healthcare utilization is crucial for enhancing maternal and child health outcomes. Despite high individual service utilization, completion of the continuum of care among many women in Kenya remains suboptimal, with significant attrition across the stages of care. This study examined socioeconomic and sociodemographic inequalities in the continuum of maternal healthcare utilization in Kenya. Methods This study used the 2022 Kenya Demographic and Health Survey, specifically the womens file. A total of 13,612 women aged 15-49 years who had a live birth within 5 years before the survey were included in the analysis. Continuum of care was categorized as no, partial, or complete. A multivariable multinomial logistic regression model was used to estimate inequalities across the continuum of care, with no continuum as the reference category. Results were expressed as adjusted Relative Risk Ratios (aRRR) with 95% confidence intervals. Results Overall, approximately 36.6% (95% CI: 35.1-38.0) achieved a complete continuum, while a majority, 60.8% (95% CI: 59.3 - 62.2), achieved a partial continuum. In terms of individual service utilization, 67% of women had 4 or more antenatal care contacts, 62% had a skilled delivery, and 54% had a postnatal visit within 48 hours of delivery. We observed inequalities across parity, age, wealth quintiles, education, pregnancy intention, place of residence, and media exposure that influenced both the partial and complete continuum of maternal healthcare utilization. Conclusion Approximately one-third of women in Kenya received a complete continuum of care during the prenatal and postnatal periods. The government and stakeholders should prioritize targeted, equity-focused interventions for women with no education and those from low-income households to increase service utilization. Non-governmental organizations and the Ministry of Health should also intensify media sensitization and expand access to family planning services.