Integrating Health Products and Behavior Change with Antenatal Services in Kenya

Kenyan mother and child


Too few expectant mothers in rural western Kenya receive the recommended amount of antenatal care (ANC) and most pregnant women do not deliver in the presence of a skilled birth attendant, despite the proven effectiveness of proper prenatal care to save newborn and maternal lives. Similarly, too few women use preventive health goods such as safe water filters and bednets, even though doing so could improve their own health and that of their children.

Many factors contribute to the under-utilization of antenatal care and important health products. Health clinics are often understaffed, and nurses may have inadequate training and supplies. Mothers often face financial barriers, may lack basic health knowledge, and do not perceive the benefits of ANC or important health products.

The Project

RAND and the Centers for Disease Control are partnering with the Safe Water and AIDS Project (SWAP), an umbrella organization of more than 300 community health promoters (CHPs), who sell health-promoting products such as handsoap, bednets, and water treatment products as an income-generating activity that also benefits the wider community.

For this project, these CHPs are partnering with local antenatal clinics, which have received a one-time infusion of updated staff training and basic supplies. The clinics are arranging for group-based antenatal care for women who share similar due dates. The group-based peer networks can facilitate greater engagement with the health facilities and a strong support network for behavior change among the women, while easing the workload for overstretched clinic nurses by streamlining their service delivery.

During these group-based appointments, SWAP’s CHPs will provide additional lessons on important health and hygiene topics such as handwashing and breastfeeding, to take advantage of pregnancy as a “teachable moment” for behavior change more generally. CHPs can also offer their health products for sale during these group appointments, thus targeting populations who can benefit the most from their adoption: pregnant mothers and those with young children.

Between appointments, women can receive appointment reminders and educational text messages via SMS on health topics relevant to their stage of pregnancy. CHPs will also offer installment payment plans, with payments collected via mobile banking, to make affordable their more expensive durable health products, such as water filters (see related project).


RAND and SWAP began implementing this year-long project in 20 clinics (10 treatment, 10 control) in November 2013. For the next year they will observe rates of women beginning antenatal care early, attending the recommended four antenatal appointments, purchasing health products, and giving birth in a health facility.


This project is made possible through the generous support of the Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Government.

Principal Investigator

Jill Luoto, Associate Economist