Utilization of Eight Antenatal Care Contacts Among Adolescent and Adult Mothers at a Referral Hospital in Western Kenya. A Comparative Cross-Sectional Study

Background: The World Health Organization (WHO) recommends eight antenatal care (ANC) contacts to improve maternal and neonatal outcomes, but adherence is challenging, particularly in low- and middle-income countries. This study investigated factors influencing the frequency of ANC contacts among adolescent and adult mothers under the new ANC model in Kenya. Methods: We conducted a comparative analytical cross-sectional study at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu, Kenya, recruiting a stratified random sample of 292 mothers (73 adolescents and 219 adults). Data was collected using a pre-tested questionnaire and a review of the Mother and Child Health Handbook. We used descriptive statistics, chi-square test and multivariable logistic regression analysis to identify associated factors with statistical significance set at p<0.05. Results: Adolescent mothers had less insurance coverage (26%) compared to adult mothers (9.1%) (p=0.001) and were more likely to report distance as a barrier (42.5%,p=0.016). Average ANC contacts were low for both groups (4.87 for adult mothers and 4.40 for adolescent mothers). The completion rate of eight ANC contacts was low for both groups (10.5% for adult mothers and 8.2% for adolescent mothers). A key finding was the inverse relationship between pregnancy risk and ANC contact frequency. Mothers with low-risk pregnancies (AOR=3.0475, p=0.00542) and moderate risk (AOR=2.6465, p=0.02169) were significantly more likely to attend more ANC contacts than those with high-risk pregnancies. Conclusion: Both adolescent and adult mothers had low adherence to the eight-contact ANC model. The inverse relationship between pregnancy risk and ANC contact frequency highlights a critical gap in care for those who need it most. We recommend health campaigns, follow-up systems for adolescent mothers, and re-evaluation of clinical pathways for high-risk mothers.