Gap between contact and content in maternal and newborn care: An analysis of data from 20 countries in sub-Saharan Africa

Abstract

Background: Over the last decade, coverage of maternal and newborn health indicators used for global monitoring and reporting have increased substantially but reductions in maternal and neonatal mortality have remained slow. This has led to an increased recognition and concern that these standard globally agreed upon measures of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) only capture the level of contacts with the health system and provide little indication of actual content of services received by mothers and their newborns. Over this period, large household surveys have captured measures of maternal and newborn care mainly through questions assessing contacts during the antenatal, delivery and postnatal periods along with some measures of content of care. This study aims to describe the gap between contact and content -as a proxy for quality- of maternal and newborn health services by assessing level of co-coverage of ANC and PNC interventions.

Methods: We used Demographic and Health Surveys (DHS) data from 20 countries between 2010 and 2015. We analysed the proportion of women with at least 1 and 4+ antenatal care visit, who received 8 interventions. We also assessed the percentage of newborns delivered with a skilled birth attendant who received 7 interventions. We ran random effect logistic regression to assess factors associated with receiving all interventions during the antenatal and postnatal period.

Results: While on average 51% of women in the analysis received four ANC visits with at least one visit from a skilled health provider, only 5% of them received all 8 ANC interventions. Similarly, during the postnatal period though two-thirds (65%) of births were attended by a skilled birth attendant, only 3% of newborns received all 7 PNC interventions. The odds of receiving all ANC and PNC interventions were higher for women with higher education and higher wealth status.

Conclusion: The gap between coverage and content as a proxy of quality of antenatal and postnatal care is excessively large in all countries. In order to accelerate maternal and newborn survival and achieve Sustainable Development Goals, increased efforts are needed to improve both the coverage and quality of maternal and newborn health interventions.

Figure 1

A. Percentage of women with a live birth in last 2 years receiving the complete set of 8 antenatal care (ANC) interventions; average across 18 countries, Demographic and Health Surveys (DHS) 2010–2015. The analysis included 18 countries as Burundi, and Rwanda did not have information about the full set of interventions. B. Percentage of women with at least one ANC visit and women with four or more visits by ANC intervention received; average across 18 countries, DHS 2010–2015. The analysis included 18 countries as Burundi, and Rwanda did not have information about the full set of interventions.

Figure 2

Odds ratios, 95% confidence intervals and p–values of receipt of all 8 antenatal care (ANC) interventions among women with antenatal contact from random effect logistic regression, (pooled Demographic and Health Surveys (DHS) data from 18 countries, DHS 2010–2014). The analysis included 18 countries as Burundi, and Rwanda did not have information about the full set of interventions.

Figure 3

Percentage of newborns/mothers by type of intervention received during postnatal period, average across 17 countries, Demographic and Health Surveys (DHS) 2010–2015. The analysis included 17 countries as Cameroon, Mozambique and Zimbabwe did not have information about the full set of interventions.

Figure 4

Odds ratios, 95% confidence intervals and p–values of receipt of all postnatal care (PNC) interventions from random effect logistic regression (pooled Demographic and Health Surveys (DHS) data from 17 countries, DHS 2010–2014). The analysis included 17 countries as Cameroon, Mozambique and Zimbabwe did not have information about the full set of interventions.