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. 2018 Apr 12;3(2):e000779.
doi: 10.1136/bmjgh-2018-000779. eCollection 2018.

Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries

Lenka Benova  1 , Özge Tunçalp  2 , Allisyn C Moran  3 , Oona Maeve Renee Campbell  1
Affiliations

Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries

Lenka Benova et al. BMJ Glob Health. .

Abstract

Introduction: Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related.

Methods: We used the most recent Demographic and Health Survey to analyse ANC related to women's most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components.

Results: In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti.

Conclusion: Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.

Keywords: cross-sectional survey; health services research; maternal health.

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Conflict of interest statement

Competing interests: LB reports receiving a research grant from Merck Sharp and Dohme (MSD) through its MSD for Mothers programme.

Figures

Figure 1
Figure 1
Included countries and selected population indicators. ANC, antenatal care; DRC, Democratic Republic of Congo.
Figure 2
Figure 2
Distribution of cumulative number of antenatal care (ANC) visits among women with a live birth, by country. DRC, Democratic Republic of Congo.
Figure 3
Figure 3
Box plot of number of antenatal care (ANC) visits among ANC users, by country. DRC, Democratic Republic of Congo.
Figure 4
Figure 4
Combination of timing of first visit and number of visits among ANC users, by country. ANC, antenatal care; DRC, Democratic Republic of Congo.
See this image and copyright information in PMC

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