Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

Abstract

IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar.MethodsWe examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC.ResultsApproximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84).ConclusionThe 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.

Extent of Received Antenatal Care Components in Ethiopia: A Community-Based Panel Study

“…Our study revealed that the proportion of adequately received ANC contents was 28%. This result is in line with a study conducted in LMICs ranging from 10 to 50% in Jordan, Nigeria, Nepal, Colombia, and Haiti 49 and studies in Bangladesh (22%), 20 Zambia (29%), 16 but lower than studies done in Ghana (48%), 23 Myanmar (58%), 41 Zambia (47.1%), 50 and higher than studies in Nigeria (7%), 22 twenty countries in sub-Saharan Africa (5%). 51 The slow progress towards maternal and newborn survival due to ineffective care may be attributable to the gaps between globally recommended coverage indicators measuring contacts rather than the actual content.…”

“…Similarly, studies indicate that rural resident women were significantly less likely to have higher numbers of content items of ANC services. 9 , 20 , 22 , 41 Rural women have substantially less or even absent transportation infrastructure which makes access to healthcare difficult and may contribute to the difference. 52 The study also revealed long distances to health institutions and low media exposure among rural women contributed to inadequate received ANC components.…”

“…Based on the woman’s response, researchers created a composite index of ANC content received which included a simple count of the number of care components received by the women. 20 , 23 , 41 A minimum value of zero indicates that the woman did not receive any items and a maximum value (12) shows she has utilized all items. Furthermore, we dichotomized the received ANC content as those who received greater than or equal to 75 percentiles as received adequate ANC content and less than as inadequate.…”

The relationship between time spent during the first ANC contact, home visits and adherence to ANC contacts in Ghana

“…The prevalence of eight or more ANC contacts according to our study was 31.2% among mothers in the Nabdam district of Ghana. This prevalence is higher than previous findings from Benin (8%), Bangladesh (6%), and Myanmar (18%) [9][10][11]. The higher prevalence observed in our study be due to the free maternal healthcare policy in Ghana [19].…”

“…However, many low-and-middle-income countries (LMIC) are neither meeting the recommended number of eight ANC contacts nor adhering to the number of contacts per trimester of pregnancy [ 7 , 8 ]. A recent study in Benin reported that 8% of pregnant women had eight or more ANC contacts with the healthcare provider [ 9 ], while other studies in Bangladesh and Myanmar reported that only 6% and 18% of pregnant women respectively, had eight or more ANC contacts [ 10 , 11 ].…”