The 2025/26 Kenya Mini Demographic and Health Survey, released on Tuesday, shows that the average number of children women have is falling, with education, household wealth and place of residence emerging as key factors influencing reproductive patterns./HANDOUT

Kenya’s fertility rate has declined to 3.1 children per woman, but maternal deaths remain a major public health concern despite improvements in access to health services, a new government survey has found.

The national fertility rate has dropped from 3.4 children per woman recorded in the previous survey.

Women in rural areas have more children on average than those living in towns and cities. The latest findings put rural fertility at 3.6 children per woman, compared with 2.6 in urban areas.

Rosemary Bowen, Director of the Population and Social Statistics Directorate at the Kenya National Bureau of Statistics (KNBS), said the figures reflect significant differences in childbearing patterns across the country.

Education also plays a major role. Women without formal education have an average of 5.4 children, compared with 2.7 among those who have attained secondary education.

The gap is similarly evident across household income levels. Women in the lowest wealth category have an average of 4.5 children, while those in the wealthiest households have 2.3.

Fertility rates also differ considerably between counties. Mandera records the highest rate at 6.8 children per woman, while Embu has the lowest at 2.2.

Nyandarua follows with 3.8 children per woman, while Nakuru, Kakamega and Vihiga each record 3.5. Murang’a, Nandi and Bomet have rates of 3.4, while Kisumu and Nyamira stand at 3.2. Uasin Gishu records 3.0.

According to KNBS, 31 of the country's 47 counties have fertility rates above the national average.

The survey further shows that women are taking longer between pregnancies. The median interval between births has increased to 48.3 months, up from 43.1 months recorded in the 2022 Kenya Demographic and Health Survey.

Birth rates are highest among women aged between 25 and 29, at 161 births per 1,000 women. Among teenagers aged 15 to 19, the rate stands at 63 births per 1,000 women.

The report notes that delaying the first pregnancy and allowing longer intervals between births have contributed to declining fertility. Such intervals also reduce health risks associated with closely spaced pregnancies, including premature births and low birth weight.

Despite these changes, maternal mortality remains a significant challenge.

The maternal mortality ratio has fallen to 263 deaths per 100,000 live births, compared with 362 in the 2022 survey and 520 recorded in the 2003 survey.

Medical Services Principal Secretary Ouma Oluga welcomed the improvement but said the country still had a long way to go to meet its target.

“The maternal mortality ratio, which we have been seeing in the 300s, for the first time we are going to start seeing a number that is lower, which means that we've made progress at 263 per 100,000. But that's not enough. Our target is to get to 70 and below,” Oluga said.

The global target is fewer than 70 maternal deaths per 100,000 live births.

The survey links the progress partly to increased use of health facilities for childbirth. The proportion of women delivering in health facilities has risen from 88 per cent to 91 per cent.

However, access remains unequal. Facility-based deliveries range from 47 per cent in Garissa to 100 per cent in Nairobi, Nyandarua and Nyeri.

Antenatal care attendance has also improved, with the proportion of women making at least four visits rising from 66 per cent to 72 per cent.

The share of pregnant women attending their first antenatal clinic during the first three months of pregnancy has increased from 29 per cent to 36 per cent.

However, only 9.5 per cent complete the recommended eight antenatal care contacts, highlighting gaps in monitoring pregnancies and identifying complications early.

The survey also records a sharp increase in Caesarean section deliveries. Their share has risen five-fold, from four per cent in 2003 to 20 per cent in 2025/26.

Modern contraceptive use currently stands at 56 per cent, pointing to continued gaps in access to family planning services.