Understanding the choices surrounding pregnancy self-test use among women attending antenatal care in Western Kenya.

Full Description: The pregnancy self-test was first sold in North America in the 1970s and provided a means for women to discreetly assess their pregnancy status in the privacy of their homes. Despite increasing evidence that women who use pregnancy tests on their own are more likely to present for antenatal care early, about 20% of women enrolling in antenatal care clinics in western Kenya used a pregnancy test to confirm their pregnancies. Moreover, about 35% of women attended antenatal care in the first trimester of pregnancy. We have a unique opportunity to shape the future of maternal health and improve access to antenatal care in western Kenya by encouraging the increased use of pregnancy tests. However, we first need to understand the factors influencing women’s choices to use a pregnancy test in early pregnancy.

From May 2021 – July 2021, we conducted phone interviews with a random sample of women from four antenatal care clinics in Homa Bay and Siaya counties in Kenya. We selected the women based on whether they used a pregnancy test or went for antenatal care in the first trimester. Interviews were audio-recorded, transcribed, and translated as needed. We conducted a thematic analysis to understand women’s choices surrounding test use. In total, we interviewed 48 women with a median age of 28 years (IQR: 24.5, 32.5) and a median of 2 pregnancies (IQR: 1.5, 3.0). Most women had completed a secondary level education or higher (72%) and had some form of employment (65%).

Certain kinds of knowledge or perceptions led women not to use a pregnancy test. Women who knew the signs of pregnancy and knew that they were pregnant did not see the value in using a pregnancy test. In some cases, women who felt sick in early pregnancy did not know they were pregnant and therefore did not consider using a pregnancy test and decided to go directly to the clinic for a checkup. Women who did not know how to use a pregnancy test or had never used one did not consider using a pregnancy test. Some women did not trust the accuracy of pregnancy tests purchased from a pharmacy but instead trusted the clinic and believed that they would get a truthful result at the clinic. In some cases, women did not use a pregnancy test because of a lack of access or resources (e.g., the pharmacy was too far or the test was too expensive). There were also particular conveniences associated with going to the clinic (testing was free, and women could access other services). In general, women who used a pregnancy test on their own suspected that they were pregnant based on signs and symptoms, were eager to know their pregnancy status, and wanted to confirm first by themselves to avoid visiting the clinic unnecessarily.

Our findings suggest that improved education of women on the signs and symptoms of pregnancy, how pregnancy tests work, and their benefits, as well as making pregnancy tests more affordable and accessible in the community, can improve pregnancy test use in early pregnancy.

Abbreviated Description: Despite increasing evidence that women who use a pregnancy test on their own are more likely to present for antenatal care early, about 20% of women enrolling in antenatal care clinics in Western Kenya used a pregnancy test to confirm their pregnancies. We, therefore, sought to understand women’s choices surrounding the use of pregnancy tests and conducted phone interviews with 48 women from four antenatal care clinics in Homa Bay and Siaya counties in Kenya. Our findings suggest that improved education of women on the signs and symptoms of pregnancy, how pregnancy tests work, and their benefits, as well as making pregnancy tests more affordable and accessible in the community, can improve pregnancy test use in early pregnancy.

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