Background: Antenatal care (ANC) is vital for the health of both mother and fetus. Generally, it has been observed that lack of prenatal care or inadequate utilization of antenatal care culminates in adverse maternal outcomes including maternal mortality. Objective: To compare the obstetric outcomes in pregnant women that commenced ANC in the third trimester with those that initiated ANC contacts early. Materials and Methods: This was a prospective cohort study conducted on antenatal attendees that booked and delivered at the

Background: Payment methods for healthcare services in a country impact the health status of its people and the health indices of the nation. Research findings have shown that care received and obstetric outcomes of women seeking natal care and their newborns are affected by their health insurance status. Objective: Comparative study of obstetric outcomes between women on health insurance scheme and women on out -of-pocket payment. Materials and Methods:The study was a prospective observational one involving1655 women who delivered during the period of the study, out of which 33 were on health insurance and 1622 paid out of pocket for their delivery and care. The study compared the obstetric outcomes between women on health insurance and those who pay out of pocket for obstetric care services. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for the data analysis. Univariate association between mode of payment and obstetric outcomes was explored using Pearson's chi-square test with statistical significance, p-value set at p<0.05. Results: Both the employed (66.7% vs 33.3%) and unemployed (77.1% vs 22.9%) had preponderance for the use of health insurance. There was statistical significance between ethnicity (p=0.03), marital status (p<0.001) and mode of payment. Among those who had preeclampsia, 20% had health insurance while 80% paid out of pocket. All the women (100%) who had intrauterine growth restriction (IUGR) were on health insurance while 76.2% of those who did not have IUGR made use of OOP, with statistical significance (p=0.01). The special care baby unit (SCBU) admission for babies of mothers on health insurance was 9.1% compared to 17.2% of those on out of pocket payments. Babies whose mothers made out of pocket payments suffered early neonatal death (END) compared to none among the babies of those that were insured. Conclusion:The study concluded that out of pocket payment by pregnant women leads to poor obstetric and fetal outcomes.