Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India

Abstract

Evidence to support that antenatal screenings and interventions are effective in reducing maternal mortality has been scanty and studies have presented contradictory findings. In addition, antenatal care utilization is poorly characterized in studies. As an exposure under investigation, antenatal care should be well defined. However, measures typically only account for the frequency and timing of visits and not for care content. We introduce a new measure for antenatal care utilization, comprised of 20 input components covering care content and visit frequency. Weights for each component reflect its relative importance to better maternal and child health, and were derived from a survey of international researchers. This composite measure for antenatal care utilization was studied in a probability sample of 300 low to middle income women who had given birth within the last three years in Varanasi, Uttar Pradesh, India. Results showed that demarcating women's antenatal care status based on a simple indicator--two or more visits versus less--masked a large amount of variation in care received. Logistic regression analyses were conducted to examine the effect of antenatal care utilization on the likelihood of using safe delivery care, a factor known to decrease maternal mortality. After controlling for relevant socio-demographic and maternity history factors, women with a relatively high level of care (at the 75th percentile of the score) had an estimated odds of using trained assistance at delivery that was almost four times higher than women with a low level of care (at the 25th percentile of the score) (OR = 3.97, 95% CI = 1.96, 8.10). Similar results were obtained for women delivering in a health facility versus at home. This strong positive association between level of care obtained during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.

PIP: A new measure for antenatal care utilization is introduced, comprised of 20 input components on care content and visit frequency. Weights for each component reflect the component's relative importance to better maternal and child health, and were derived from a survey of international researchers. The measure was studied in a probability sample of 300 low- to middle-income women who had given birth within the past 3 years in Varanasi, Uttar Pradesh, India. After controlling for relevant sociodemographic and maternity history factors, analysis of the data found that the use of antenatal care among low- to middle-income women in Varanasi positively influences the likelihood of using trained assistance at the birth of the child. Women with a relatively high level of care had an estimated odds of using trained assistance at delivery that was almost 4 times higher than women with a low level of care. Similar results were obtained for women delivering in a health facility rather than at home. This strong positive association between level of care during pregnancy and the use of safe delivery care may help explain why antenatal care could also be associated with reduced maternal mortality.