Care for All Mothers and Newborns: Measuring Coverage and Content of Care

Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: To track maternal and newborn health care, population-based estimates rely on household surveys which focus on coverage of antenatal (ANC), skilled birth attendance (SBA) and postnatal care (PNC), as prioritized by the Commission for Information and Accountability. Yet these metrics only assess contact, not content or quality of care. We approximate quality of services by assessing mothers’ report of selected interventions during these periods in Demographic and Health Surveys (DHS).

Methodology: We used DHS data for antenatal, intrapartum and postnatal care, 2010-2014 in 21 countries. We analysed the proportion of pregnant women with at >ANC and those with >4 visits, who received seven interventions. For PNC, we analysed women delivering with a skilled birth attendant (SBA) whose newborn received seven interventions. We carried out random effect logistic regression to assess factors associated with receiving all interventions.

Results: Although 61% to 99% of women received at least one ANC visit with a SBA across the 21 countries, only 2% to 41% received all seven ANC interventions. Women who had four or more ANC visits were more likely to receive all seven interventions, but the proportions remained low, ranging from 3% to 46%. For PNC, between 1% and 13% of newborns received all seven interventions, despite their mothers having SBA. Characteristics associated with receipt of seven ANC interventions included urban residence, wealth, low parity, age 30-39, education, at least 4 ANC visits, and ANC with a doctor. For PNC; wealth, marriage and education were significantly associated with receipt of all seven interventions.

Conclusion: The coverage-quality gap is large in all these countries, with less than half receiving the interventions assessed, lower for poorer families. More action is needed to strengthen the quality of care, as well as coverage; improved indicators and data will be integral to inform and monitor this programmatic shift.