How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence

Abstract

This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them.

Factors associated with non-utilisation of health service for childbirth in Timor-Leste: evidence from the 2009-2010 Demographic and Health Survey

“…ANC has a number of benefits. It provides an opportunity for communication between mothers and health workers [27,28]. The WHO has recommended that health workers should help mothers to prepare a plan for childbirth [26,29].…”

Implementation of evidence-based antenatal care in Mozambique: a cluster randomized controlled trial: study protocol

“…ANC visits constitute one of the few times women in many resource-poor settings seek care for their own health [9,10] and, therefore, represent an important opportunity for: 1) reaching women with a number of interventions that may be vital for their health and the health of their unborn child (e.g. anaemia, HIV, syphilis and malaria prevention, detection and treatment), and 2) informing women about pregnancy, related complications, and the advantages of skilled delivery care as well as the importance of birth spacing [11,12].…”

What socioeconomic factors are associated with different levels of antenatal care visits in Bangladesh? A behavioral model

“…It includes providing health information about pregnancy complications and danger signs, symptoms, and risks of labor and delivery, importance of seeking medical care, and delivery with the assistance of skilled health care personnel (WHO, 1994). Many health problems related to pregnancy are preventable, detectable, or treatable by trained health workers (Carroli, Rooney, & Villar, 2001;WHO, 1994). In addition, researchers showed that ANC visits during pregnancy have positive impact on postnatal utilization of health services which have a positive impact on the health status of the child (Dhakal et al, 2007;Oyerinde, 2013) including a reduction in neonatal deaths (Fottrell et al, 2013).…”