Inequality in time to first antenatal care visits and its predictors among pregnant women in India: an evidence from national family health survey

Abstract

For countries with high maternal mortality and morbidity, on-time initiation of antenatal care (ANC) is indispensable. Therefore this paper aims for studying the median survival time (MST) of first ANC among pregnant women as well as understanding the contextual factors that influence a mother’s decision to access ANC services in India. The study used cross-sectional survey data obtained from the NFHS-4 conducted in 2015–2016. The MST of the timing of the first ANC visit was estimated using the Kaplan-Meir estimate. A multivariate Cox-proportional hazard regression model was used to identify the factors related to the timing of the first ANC visit with a 95% confidence interval (CI). Overall at least one ANC checkup was assessed by 60.15% of women and the median survival time for the first ANC checkup was found to be 4 months. Early initiation of ANC in pregnant women increased by 37% (AHR: 1.37, CI:1.34–1.39) for primary education, and 88% (AHR:1.88, CI:1.86–1.90) for secondary education compared to women having no formal education. Results of the current study revealed that the median survival time of the first ANC visit was 4 months in India which is delayed compared to recommendations of WHO. Therefore boosting the access and utilization of antenatal care coverage among pregnant women can ensure the best health outcomes for their pregnancy.

Individual and community level determinants of delayed antenatal care initiation in Ethiopia: A multilevel analysis of the 2019 Ethiopian Mini Demographic Health Survey

“…The current study revealed that mothers who belong to the poorest and poorer socioeconomic statuses were 90% more likely to delay their ANC initiation compared to those with the richest socioeconomic status. This finding supports the results of studies conducted in Ethiopia [ 22 ], Ghana [ 33 ], and India [ 41 , 42 ]. This might be due to the out-of-pocket expenditure associated with the service.…”

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model

“…The mean survival time of pregnant women to initiate ANC visits in this study was significantly higher than a study done in India in which the reported median survival time to the first ANC visit was 4 months. 33 The finding of this study is also slightly higher than the study finding from Nigeria in which the median survival time for the first ANC check-up was found to be 6 months. 34 Moreover, this finding is higher when compared with the recent findings of average of 3.4 gestational months before initiation of ANC visits in Ghana.…”

“… 11 33 39 A study conducted in India revealed that women with higher education had a 2.8 times shorter time to initiate ANC in the first trimester of pregnancy compared with women having no formal education. 33 Similarly, in Nepal, women with higher-level education were significantly more likely to initiate ANC early compared with women who had no education. 39 A multicountry analysis of DHS in SSA found that the odds of timely initiation of ANC were higher in mothers who had a higher level of education compared with women who had no formal education.…”

“… 11 33 41 42 A study finding from India has shown that women with a birth order of four and above had a 16% prolonged time to initiate ANC compared with primiparous women. 33 In Malawi, women with more than five births were 12% less likely to access ANC services in their first trimester of pregnancy. 42 In Nigeria, women with one birth were more likely to initiate ANC in the first trimester compared with women with five and more births.…”

“…In India, urban residents had a 49% probability of initiating ANC early in the first trimester of pregnancy compared with their rural counterparts. 33 In SSA, women residing in the rural area were less likely to initiate ANC timely within 12 weeks of gestation. 10 In Nigeria, women in urban areas were more likely to make the first ANC visit early in the first trimester of pregnancy.…”