Maternal & Reproductive Health

Executive Summary

The Maternal & Reproductive Health Program is a comprehensive, multi-sectoral initiative designed to address the persistent challenges of maternal mortality, morbidity, and limited access to reproductive health services in Kenya. Launched in 2025, this flagship program represents UWRA's commitment to translating evidence into actionable solutions that improve the health and well-being of women, mothers, and their families. It recognizes that maternal and reproductive health is not only a matter of individual well-being but also a fundamental driver of community health, economic development, and social equity.

The program is grounded in a thorough understanding of the complex determinants of maternal and reproductive health, including access to quality antenatal care, skilled birth attendance, emergency obstetric care, family planning, and post-natal support. It addresses both the supply-side constraints — such as inadequate health infrastructure, shortages of skilled health workers, and weak referral systems — and the demand-side barriers, including cultural norms, financial constraints, and lack of awareness. The program adopts a holistic, life-course approach that spans adolescence through the reproductive years and beyond.

Working across four counties in Kenya, the program combines direct health service delivery with capacity strengthening, community mobilization, and policy engagement. It is implemented in close partnership with county health departments, community-based organizations, and international partners. The program is designed to be scalable and replicable, with a robust monitoring and evaluation framework that enables continuous learning and adaptation.

Background & Rationale

Kenya continues to face significant challenges in maternal and reproductive health. According to recent demographic and health surveys, the maternal mortality ratio remains unacceptably high at approximately 362 deaths per 100,000 live births. While progress has been made, the country is unlikely to achieve the Sustainable Development Goal target of 70 deaths per 100,000 live births by 2030 without accelerated efforts. The leading causes of maternal death include hemorrhage, sepsis, hypertensive disorders, and complications of unsafe abortion — all of which are largely preventable with timely and quality care.

Access to skilled birth attendance remains suboptimal, with only about 70% of births attended by a skilled provider nationally, and rates significantly lower in rural and underserved areas. Antenatal care coverage is high in terms of at least one visit, but the quality and content of care vary widely, and only a minority of women receive the recommended eight contacts. Family planning services are underutilized, with an unmet need for family planning of approximately 14%, contributing to high rates of unintended pregnancies and unsafe abortions.

The consequences of poor maternal and reproductive health are profound and intergenerational. Maternal mortality and morbidity undermine the health and well-being of families, communities, and societies. They contribute to poverty, orphanhood, and the perpetuation of disadvantage. Improving maternal and reproductive health is therefore not only a health priority but also a human rights and development imperative.

Despite the existence of evidence-based interventions to prevent and manage maternal complications, their coverage and quality remain suboptimal. There is a need to scale up proven interventions, strengthen health systems, and address the social and cultural determinants of maternal health. The Maternal & Reproductive Health Program is designed to contribute to these goals by implementing a package of high-impact interventions that are tailored to local contexts, integrated with existing health services, and responsive to the needs and priorities of women and communities.

Program Objectives

The program is guided by a set of clear, measurable objectives that address the multiple determinants of maternal and reproductive health.

Program Components

The program is organized around five interconnected components that address the multiple determinants of maternal and reproductive health.

Component 1: Antenatal Care and Birth Preparedness

This component focuses on improving the quality and coverage of antenatal care services and promoting birth preparedness among pregnant women and their families. It includes training health workers on the focused antenatal care model, including the recommended eight contacts, risk assessment, and management of common complications. The component supports the provision of essential antenatal services, including tetanus toxoid immunization, iron and folic acid supplementation, malaria prophylaxis, and screening for HIV and syphilis. It also includes community-based interventions to promote birth preparedness, including the development of birth plans, identification of a skilled birth attendant, and preparation for emergency transport.

Component 2: Skilled Birth Attendance and Emergency Obstetric Care

This component aims to increase the proportion of births attended by skilled health professionals and to improve the quality of emergency obstetric care. It includes training and mentoring of health workers in essential and emergency obstetric care, including the management of hemorrhage, eclampsia, sepsis, and other life-threatening conditions. The component supports the strengthening of referral systems between communities, health facilities, and hospitals, ensuring that women with complications can access timely care. It also includes the provision of essential supplies and equipment for emergency obstetric care, including uterotonics, antibiotics, and blood transfusion supplies.

Component 3: Family Planning and Reproductive Health

This component focuses on expanding access to and utilization of voluntary family planning services. It includes the training of health workers on family planning counseling and services, including the provision of a wide range of contraceptive methods, such as oral contraceptives, injectables, implants, and intrauterine devices. The component supports the integration of family planning into maternal and child health services, as well as the establishment of youth-friendly services. It also includes community-based interventions to address myths and misconceptions about contraception and to promote informed choice. The component works to ensure that all services are provided with respect for human rights and dignity.

Component 4: Post-Natal Care and Newborn Health

This component aims to improve the quality and coverage of post-natal care for mothers and newborns, ensuring that potential complications are detected early and managed effectively. It includes the training of health workers on post-natal care, including monitoring for hemorrhage, infection, and hypertensive disorders; counseling on breastfeeding, nutrition, and family planning; and support for maternal mental health. The component also includes community-based follow-up of mothers and newborns in the first week after birth, as well as the promotion of essential newborn care practices, such as immediate and exclusive breastfeeding, Kangaroo Mother Care, and recognition of danger signs.

Component 5: Adolescent Reproductive Health and Empowerment

This component focuses on promoting adolescent reproductive health and empowering young people to make informed decisions about their health and well-being. It includes the implementation of comprehensive sexuality education programs in schools and communities, covering topics such as puberty, relationships, contraception, HIV and STI prevention, and gender equality. The component supports the establishment of youth-friendly health services that are accessible, confidential, and non-judgmental. It also includes community engagement to address harmful social norms and practices, such as child marriage and female genital mutilation, and to promote the rights of adolescents.

Target Populations

The program targets vulnerable populations in four counties in Kenya. The primary beneficiaries include:

• Pregnant and lactating women: These women are the primary beneficiaries of antenatal care, skilled birth attendance, and post-natal care interventions.
• Adolescents: Adolescents, especially girls, are reached through comprehensive sexuality education, youth-friendly services, and empowerment programs.
• Women of reproductive age: Women are supported through family planning services, reproductive health education, and access to health services.
• Community health workers and health facility staff: These frontline workers are trained and supported to deliver quality maternal and reproductive health services.
• Community leaders and men: Community leaders and men are engaged to address social norms and support women's access to health services.

Implementation Approach

The program is implemented through a multi-stakeholder, participatory approach that involves communities, county governments, and other partners at all stages. The following principles guide our implementation approach:

• Community Engagement: We work in close collaboration with communities to co-design and co-implement interventions, ensuring that they are relevant, acceptable, and sustainable.
• Integration: The program is integrated with existing health services, including maternal and child health, family planning, and reproductive health services.
• Partnerships: We collaborate with a wide range of partners, including county health departments, community-based organizations, academic institutions, and international organizations.
• Evidence-Based: The program is grounded in the best available evidence and is continuously informed by monitoring and evaluation data.
• Equity and Inclusion: The program is designed to address inequalities and reach those who are most marginalized and underserved.
• Human Rights-Based: The program is guided by a human rights framework, ensuring that services are provided with respect for dignity, autonomy, and informed choice.

Partners

The program is implemented in partnership with a range of organizations and institutions that bring complementary expertise and resources.

• County Governments: The program works closely with county health departments to align with local priorities and systems.
• Community-Based Organizations: Local CBOs are engaged in community mobilization, outreach, and implementation of interventions.
• Academic Institutions: Partnerships with universities support research, monitoring and evaluation, and capacity strengthening.
• Private Sector: Engagement with the private sector supports innovation, service delivery, and advocacy.

Monitoring, Evaluation, and Learning

The program has a robust monitoring, evaluation, and learning (MEL) system that tracks progress toward objectives, assesses effectiveness, and generates evidence for program improvement. Key elements of the MEL system include:

• Baseline and Endline Surveys: Comprehensive household surveys measure changes in maternal health, reproductive health, and related indicators.
• Routine Data Collection: Health management information systems (HMIS) and program monitoring tools provide ongoing data on service coverage and quality.
• Qualitative Research: Focus group discussions, in-depth interviews, and participant observation explore experiences, barriers, and enablers.
• Regular Reviews: Quarterly and annual reviews enable learning and adaptation.
• Dissemination: Findings are disseminated through reports, policy briefs, presentations, and publications.

Expected Outcomes

By the end of the program, we expect to achieve the following outcomes:

• Reduced Maternal Mortality: The maternal mortality ratio will decline by at least 20% in target areas.
• Increased Skilled Birth Attendance: The proportion of births attended by skilled health professionals will increase to at least 90% in target areas.
• Improved Antenatal Care Quality: At least 80% of pregnant women will receive the recommended eight antenatal contacts.
• Expanded Family Planning Access: The modern contraceptive prevalence rate will increase by at least 15% in target areas.
• Improved Post-Natal Care Coverage: At least 80% of mothers and newborns will receive post-natal care within 48 hours of birth.
• Enhanced Adolescent Reproductive Health: Adolescents will demonstrate improved knowledge, attitudes, and practices related to reproductive health.