Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013

Abstract

SummaryBackgroundThe timing of the first antenatal care visit is paramount for ensuring optimal health outcomes for women and children, and it is recommended that all pregnant women initiate antenatal care in the first trimester of pregnancy (early antenatal care visit). Systematic global analysis of early antenatal care visits has not been done previously. This study reports on regional and global estimates of the coverage of early antenatal care visits from 1990 to 2013.MethodsData were obtained from nationally representative surveys and national health information systems. Estimates of coverage of early antenatal care visits were generated with linear regression analysis and based on 516 logit-transformed observations from 132 countries. The model accounted for differences by data sources in reporting the cutoff for the early antenatal care visit.FindingsThe estimated worldwide coverage of early antenatal care visits increased from 40·9% (95% uncertainty interval [UI] 34·6–46·7) in 1990 to 58·6% (52·1–64·3) in 2013, corresponding to a 43·3% increase. Overall coverage in the developing regions was 48·1% (95% UI 43·4–52·4) in 2013 compared with 84·8% (81·6–87·7) in the developed regions. In 2013, the estimated coverage of early antenatal care visits was 24·0% (95% UI 21·7–26·5) in low-income countries compared with 81·9% (76·5–87·1) in high-income countries.InterpretationProgress in the coverage of early antenatal care visits has been achieved but coverage is still far from universal. Substantial inequity exists in coverage both within regions and between income groups. The absence of data in many countries is of concern and efforts should be made to collect and report coverage of early antenatal care visits to enable better monitoring and evaluation.FundingDepartment of Reproductive Health and Research, WHO and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Timing and number of antenatal care contacts in low and middle-income countries: Analysis in the Countdown to 2030 priority countries

“…Conversely, timely first ANC has not been widely reported on, but has been shown to be associated with the total number of ANC contacts achieved and the content of care received [8,9]. Although the global coverage of one skilled ANC contact remains high at 86% [10], a substantially lower proportion of pregnant women initiate ANC during the first trimester [3]. Reasons associated with delayed ANC initiation include financial constraints, distance to health facilities, cultural and religious beliefs around disclosure of pregnancy status, gender norms, lack of awareness of pregnancy signs and antenatal care schedules, pregnancy wantedness, perceptions on the need to start ANC early, and quality of care received [1,[11][12][13][14][15][16][17][18][19].…”

“…Antenatal care (ANC) is a platform for the delivery of essential services to prevent pregnancy complications, provide counselling for birth and emergency preparedness [1], and improve health outcomes for children [2]. Timely initiation of antenatal care, defined as the first antenatal care contact occurring within the first trimester of pregnancy, provides an opportunity for early screening of modifiable risk-factors and pre-existing conditions [3].…”

The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy

“…In principle, public health programs to ensure adequate prenatal and intrapartum care could prevent a substantial proportion of epilepsy arising from these causes. Some disparities in access to prenatal care persist even in HIC, indicating needs for program improvement . However, the unmet need for such programs is greatest in LMIC, where >80% of the world population resides and where there are marked inequalities in the distribution of health care resources within and among countries .…”

“…53,54 However, the unmet need for such programs is greatest in LMIC, where >80% of the world population resides and where there are marked inequalities in the distribution of health care resources within and among countries. 53,55 Consequences are illustrated by estimates that in 2010 the incidence of neonatal encephalopathy was 14.9 per 1000 live births in sub-Saharan Africa, and 10.4 per 1000 in South Asia, compared to 1.5 per 1000 in HIC. 56 Few studies estimate the population attributable fraction (PAF) of perinatal problems associated with epilepsy.…”

Focussed antenatal care a possible opportunity towards safe motherhood

“…The Basic Antenatal Care (ANC) has emphasis on number of visits and hence not so popular with only an average 50% of mothers attend. [1][2][3][4][5] Over the years there have been so much socio cultural changes in the society and health care delivery system. Now we have adopted fully institutional deliveries by specialist birth attendants supported by free national ambulance service.…”