Introduction: In Kenya, maternal and child health accounts for a large proportion of the expenditures made towards healthcare. It is estimated
that one in every five Kenyans has some form of health insurance. Availability of health insurance may protect families from catastrophic spending
on health. The study intended to determine the factors affecting the uptake of health insurance among pregnant women in a rural Kenyan district.
Methods: This was cross-sectional study that sampled 139 pregnant women attending the antenatal clinic at a level 5 hospital in a Kenyan
district. The information was collected through a pretested interview schedule. Results: The median age of the study participants was 28 years.
Out of the 139 respondents, 86(62%) planned to pay for their deliveries through insurance. There was a significant relationship between insurance
uptake and marital status Adjusted odds ratio (AOR) 6.4(1.4-28.8).Those with tertiary education were more likely to take up insurance AOR 5.1
(1.3-19.2). Knowing the benefits of insurance and the limits the insurance would settle in claims was associated with an increase in the uptake of
insurance AOR 7.6(2.3-25.1), AOR 6.4(1.5-28.3) respectively. Monthly income and number of children did not affect insurance uptake.
Conclusion: Being married, tertiary education and having some knowledge on how insurance premiums are paid are associated with uptake of
medical insurance. Information generated from this study if utilized will bring a better understanding as to why insurance coverage may be low
and may provide a basis for policy changes among the insurance companies to increase the uptake.