Health facility factors associated with the uptake of free maternal health services in Turkana central sub-county

Background: Maternal mortality is still a significant public health issue in low- and middle-income countries, with Kenya reporting an average of 342 deaths per 100,000 live births-well above the global sustainable development goal (SDG) target of 70. In response, Kenya introduced the free maternity service (FMS) policy in 2013 to improve access to skilled birth attendance by eliminating user fees. However, in marginalised areas such as Turkana Central Sub-County, barriers persist that hinder the uptake of maternal health services. Methods: This cross-sectional study investigated health facility factors associated with the utilisation of free maternal services in Turkana Central. A total of 210 women-either pregnant or within six weeks postpartum-were sampled using snowball sampling, focusing on Lodwar Township. Data were collected through structured, face-to-face interviews and analysed using descriptive statistics, chi-square tests, and logistic regression. Results: Findings revealed that staff attitude and physical distance to the nearest health facility significantly influenced service uptake. Women attended by harsh staff were 4.7 times less likely to use the services (p<0.001), while those living more than 60 minutes from a facility were three times more likely to avoid them (p=0.006). In contrast, other factors such as comfort with male health workers (p=0.232), perceived accessibility (p=0.398), and waiting time at the facility (p=0.375) showed no significant association with service utilisation. Conclusions: The study concludes that improving healthcare provider attitudes and reducing physical access barriers are critical to enhancing the effectiveness of the FMS policy in Turkana Central. Targeted interventions addressing these facility-level challenges are essential for improving maternal health outcomes in underserved regions.