PATTERNS IN MATERNAL MORTALITY FOLLOWING THE IMPLEMENTATION OF A FREE MATERNAL HEALTH CARE POLICY IN KENYAN PUBLIC HEALTH FACILITIES
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Background: Reduction of pregnancy related mortalities remains one of the greatest health challenges globally. For a long time, low utilization of maternal health care services has been attributed to the unaffordability of services. The government of Kenya waived delivery charges in public health facilities through a free maternal health care policy in June 2013 with an aim of encouraging facility based deliveries and subsequently reducing maternal deaths. Objectives: To describe the causes of maternal mortality 2 years before the implementation of the free maternal health care policy in Kenya (June 2011- May 2013) and 2 years after the policy intervention (June 2013-May 2015). Design: This study was of a quasi-experimental design. Setting: The study was carried out in 77 public health facilities in Kenya. Subjects: The study subjects for this study were 872 deceased mothers. Results: The largest proportion of deaths was as a result of direct causes, 79.1% before the policy 74.9% after the policy intervention. Haemorrhage, hypertensive disorders, complications of abortion and sepsis/infections were the most common direct causes of maternal mortality pre and post policy intervention. There were no significant changes in the causes of maternal following the free maternal health care policy implementation (P>0.05). The free maternal health care policy has not improved the chances of survival for mothers delivering in the 77 public health facilities (odds ratio=0.9722). Conclusion: The implementation of the free maternal health care policy has not influenced the causes of maternal mortality in Kenyan public health facilities.