title: Maternal health care utilization in Nairobi and Ouagadougou: evidence from HDSS.
abstract: BACKGROUND
  Maternal mortality is higher and skilled attendance at delivery is lower in the slums of Nairobi (Kenya) compared to Ouagadougou (Burkina Faso). Lower numbers of public health facilities, greater distance to facilities, and higher costs of maternal health services in Nairobi could explain these differences.
  
  
  OBJECTIVE
  By comparing the use of maternal health care services among women with similar characteristics in the two cities, we will produce a more nuanced picture of the contextual factors at play.
  
  
  METHODS
  We use birth statistics collected between 2009 and 2011 in all households living in several poor neighborhoods followed by the Nairobi and the Ouagadougou Health and Demographic Surveillances Systems (n=3,346 and 4,239 births). We compare the socioeconomic characteristics associated with antenatal care (ANC) use and deliveries at health facilities, controlling for demographic variables.
  
  
  RESULTS
  ANC use is greater in Nairobi than in Ouagadougou for every category of women. In Ouagadougou, there are few differentials in having at least one ANC visit and in delivering at a health facility; however, differences are observed for completing all four ANC visits. In Nairobi, less-educated, poorer, non-Kikuyu women, and women living in the neighborhood farther from public health services have poorer ANC and deliver more often outside of a health facility.
  
  
  CONCLUSIONS
  These results suggest that women are more aware of the importance of ANC utilization in Nairobi compared to Ouagadougou. The presence of numerous for-profit health facilities within slums in Nairobi may also help women have all four ANC visits, although the services received may be of substandard quality. In Ouagadougou, the lack of socioeconomic differentials in having at least one ANC visit and in delivering at a health facility suggests that these practices stem from the application of well-enforced maternal health regulations; however, these regulations do not cover the entire set of four ANC visits.
authors.affiliation: Institute of Demographic and Life Course Studies, University of Geneva, Geneva, Switzerland; Institut National d'Etudes Démographiques, Paris, France; clementine.rossier@unige.ch.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Rossier
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Kanyiva
authors.initials: K
authors.lastname: Muindi
authors.affiliation: Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Abdramane
authors.initials: A
authors.lastname: Soura
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Blessing
authors.initials: B
authors.lastname: Mberu
authors.affiliation: Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lankoande
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya.
authors.forename: Caroline
authors.initials: C
authors.lastname: Kabiru
authors.affiliation: Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso.
authors.forename: Roch
authors.initials: R
authors.lastname: Millogo
mesh_terms: D000293:Adolescent; D000328:Adult; D002050:Burkina Faso / Q000453:epidemiology; D002648:Child; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011159:Population Surveillance; D011295:Prenatal Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Africa; anatenatal care; place of delivery; socioeconomic differences; urban