Patterns of Utilization and Equity in Antenatal Care Across 7 Countdown Countries: A Cross-Cutting Analysis

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Antenatal care (ANC) is critical for improving reproductive health and ending preventable maternal deaths. WHO recommends that pregnant women complete at least four ANC visits, and Countdown and other global monitoring efforts track the proportions of women who receive one or more visits to a skilled provider (ANC1+) and four or more visits to any provider (ANC4+). Through analysis of the frequency of ANC utilization across seven Countdown countries, this study investigated patterns of drop-off in use between ANC1 and ANC4, and explored inequalities in women’s use of ANC services.

Methodology: We analyzed DHS data from Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive results show the frequency of ANC visits by provider and content received, as well as coverage of ANC visits by household wealth quintile, women’s education, and place of residence. We collected data on policies, guidelines and programs in the seven countries through a standard questionnaire that was completed by country-based informants.

Results: Each of the seven countries had a unique pattern of ANC utilization. Three of seven countries showed a noticeable drop-off in utilization between 3 and 5 visits. Women who reported having 4 or more visits usually sought a skilled provider and received more evidence-based content. Large disparities exist in ANC coverage by household wealth, woman’s education, and type of residence, and these disparities widen as visit frequency increases.

Conclusion: Program efforts to increase and sustain women’s use of ANC in the post-2015 era must take into account country variations in utilization patterns, informed by further in-depth qualitative analysis to understand who is and who is not receiving ANC services and why. Country estimates of progress in achieving full, equitable and sustained coverage of ANC services should take these patterns into account in interpreting their data.