The population-level impact of COVID-19 on maternal healthcare utilization: evidence from the 2022 Kenya Demographic and Health Survey

Background Despite growing research attention on the impact of coronavirus disease 2019 (COVID-19) on maternal healthcare in low- and middle-income countries, substantial knowledge gaps remain about its population-level impact. This article uses population-based data to examine the extent of COVID-19 impact on maternal healthcare, population subgroups disproportionately impacted and subnational variations in such impact in Kenya. Methods This was a secondary analysis of the 2022 Kenya Demographic and Health Survey data. It involved assessing differences in maternal healthcare between the pre-pandemic (before March 2020), COVID-19 onset (March–December 2020) and COVID-19 era/recovery (2021–2022) periods. Three-level logistic regression models were estimated to examine the role of multilevel predictors and subnational variations in COVID-19 impact on maternal healthcare. Results COVID-19 significantly impacted both routine and lifesaving/emergency maternal healthcare in Kenya. Compared with births pre-pandemic, births during COVID-19 onset and era/recovery had 14% and 26%, respectively, lower likelihood of adequate antenatal care (four or more visits, starting first trimester). Births during COVID-19 onset had a 33% higher likelihood of occurring at home and 31% lower likelihood of being through C-section than pre-pandemic. Certain population subgroups were disproportionately affected, with significant subnational variations in impact. Conclusions The findings underscore a need for targeted policy/program strategies to mitigate adverse consequences of public health emergencies among disproportionately impacted population subgroups.