Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries

Abstract

BackgroundAntenatal care (ANC) is critical for improving maternal and newborn health. WHO recommends that pregnant women complete at least four ANC visits. Countdown and other global monitoring efforts track the proportions of women who receive one or more visits by a skilled provider (ANC1+) and four or more visits by any provider (ANC4+). This study investigates patterns of drop–off in use between ANC1+ and ANC4+, and explores inequalities in women’s use of ANC services. It also identifies determinants of utilization and describes countries’ ANC–related policies, and programs.MethodsWe performed secondary analyses using Demographic Health Survey (DHS) data from seven Countdown countries: Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive analysis illustrates country variations in the frequency of visits by provider type, content, and by household wealth, women’s education and type of residence. We conducted a multivariable analysis using a conceptual framework to identify determinants of ANC utilization. We collected contextual information from countries through a standard questionnaire completed by country–based informants.ResultsEach country had a unique pattern of ANC utilization in terms of coverage, inequality and the extent to which predictors affected the frequency of visits. Nevertheless, common patterns arise. Women having four or more visits usually saw a skilled provider at least once, and received more evidence–based content interventions than women reporting fewer than four visits. A considerable proportion of women reporting four or more visits did not report receiving the essential interventions. Large disparities exist in ANC use by household wealth, women’s education and residence area; and are wider for a larger number of visits. The multivariable analyses of two models in each country showed that determinants had different effects on the dependent variable in each model. Overall, strong predictors of ANC initiation and having a higher frequency (4+) of visits were woman’s education and household wealth. Gestational age at first visit, birth rank and preceding birth interval were generally negatively associated with initiating visits and with having four or more visits. Information on country policies and programs were somewhat informative in understanding the utilization patterns across the countries, although timing of adoption and actual implementation make direct linkages impossible to verify.ConclusionSecondary analyses provided a more detailed picture of ANC utilization patterns in the seven countries. While coverage levels differ by country and sub–groups, all countries can benefit from specific in–country assessments to properly identify the underserved women and the reasons behind low coverage and missed interventions. Overall, emphasis needs to be put on assessing the quality of care offered and identifying women’s perception to the care as well as the barriers hindering utilization. Country policies and programs need to be reviewed, evaluated and/or imp...

Determinants of Antenatal Healthcare Utilisation by Pregnant Women in Third Trimester in Peri-Urban Ghana

“…It therefore, supports the study of Arthur [15] that wealth still influences the ANC use in Ghana even after the introduction of the free maternal health policy. This finding is, therefore, in agreement with works of Pandey and Singh [47], Saad-Haddad et al [35], and Yadav and Kesarwani [5] that the occupational status of expectant mothers significantly influences their maternal care use.…”

“…This empowers pregnant mothers to increase control over the things which affect their lives as far their healthcare needs are concerned. In their study on the socioeconomic determinants of maternal healthcare utilisation in seven countries, Saad-Haddad et al [35] reveal that household wealth significantly influenced the facility type for accessing maternal care. Abekah-Nkrumah and Abor [36] and Rai et al [37] also found out that household income is linked with frequent use of modern healthcare.…”

Non-Utilization of antenatal care services among women of reproductive age in the Niger delta region of Nigeria: Findings from 2595 women

“…The prevalence of women who registered for antenatal during the last pregnancy is similar to the National average and to prevalence found in other studies carried out in the South West and South East of Nigeria [7,15,18,19], but higher than findings in studies carried out in Northern Nigeria [13,14]. These figures are however much lower than those of many Asian and subSaharan countries [20][21][22].…”

Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of west Africa: a cross-sectional analysis of Demographic and Health Surveys

“…Early initiation of ANC and receipt of four visits are likely to be correlated because it is more difficult to achieve the prescribed higher number of visits if a woman initiates ANC late. In addition to receiving essential interventions, studies demonstrate that women who attend ANC early and frequently are more likely to utilize skilled providers for ANC and delivery care than those who do not (22,31). Some of the reasons for late and less frequent ANC utilization among pregnant adolescents in SSA include financial barriers, lack of information about the risks of pregnancy and benefits of ANC, stigma within the community, and disrespectful treatment by health workers (21,(32)(33)(34).…”