Globally, deaths due to pregnancy and childbirth dropped from 523,000 in 1990 to 216,000 in
2015. Despite this progress, about 800 still women die every day from complications related to
pregnancy and childbirth, an equivalent of 33 deaths per hour. Sub-Saharan Africa remains
adversely affected with the region accounting for 62% of these global deaths. Most of these
maternal deaths are prevented when attended to by skilled assistants who can identify and refer
high risk pregnancies during antenatal care and provide skilled assistance during delivery.
However, access to skilled assistance, most of the time found at health facilities, is limited by user
fee which deny many women from poor households access to these services. Recent evidence now
indicates that abolition of user fee generally leads to an increase in utilization of health services.
The government of Kenya renewed its commitment of facilitating progress towards universal
coverage by removing user fee thereby providing free delivery in all public health facilities. Using
difference-in-difference and data from the Kenya Demographic and Health Survey, 2008-09 and
2014, we assess the impact of user fee removal on the utilization of public and private health
facilities for delivery. Our findings confirm an increase in utilization of delivery services in both
public and private health facilities particularly in the public sector. In conclusion, we recommend
further research to understand unintended effects of an increase in utilization of health services to
ensure quality of care is maintained in all health facilities.