Quality of Antenatal Care Services in a Developing Country: A Cross-Sectional Survey

Abstract

The global adult lifetime risk of maternal mortality is 1 in 180; in Pakistan, it is 1 in 170; in developed regions, 1 in 4,900 (Alkema et al., 2016; Filippi, Chou, Ronsmans, Graham, & Say, 2016; World Health Organization [WHO], 2015). The differences in maternal mortality between developed and developing countries are mainly due to the quality of antenatal care (ANC) available in the two groups of countries. The purpose of this study was to assess the structural and procedural quality of ANC services provided and to assess satisfaction levels of women receiving ANC services in two large hospitals in Islamabad, Pakistan. A cross-sectional survey was conducted at the hospitals' outpatient maternal and child health clinics, with a random sample of 138 women. The overall quality of ANC was rated as good (61%), average (17.5%), or poor (17.5%). The findings suggest a need to cultivate quality of care at public health facilities, train health workers in communication skills, and build technical capacity by continuing education and supportive supervision to train health-care providers to follow standard protocols for provision of quality ANC services.

Assessment of quality of antenatal care services in public sector facilities in India

“…The inadequacy of and inequity in quality of antenatal care (ANC) services is increasingly receiving attention 1–7. The key elements of ANC services captured under the facility surveys also indicate inadequate quality of care provision 8.…”

Pregnant Women’s Perceptions of the Quality of Antenatal Care in a Public Hospital in Punjab, Pakistan during COVID-19: A Cross-Sectional Study

“…On the contrary, in Pakistan, such online appointment and counselling systems could not be operated due to the poor infrastructure and lack of education of the participants. In a study carried out in Pakistan, before the pandemic, only 17.5% of participants rated the overall quality of services as poor, while 61% rated it as good, and 17.5% as average [ 35 ]. During the pandemic, deterioration in perceived quality was observed as shown by the current study results.…”

“…These two studies show the strengths of public midwife programs in ensuring the continuity of care and the weakness of these programs in Pakistan. This dissatisfaction with the quality of service that was seen in our study participants can make them want to give birth at home, which is linked to poor birth outcomes, such as an increased risk of maternal death and illness, stillbirths, and neonatal death [ 35 ].…”

Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India

“… 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 Much of the available literature on ANC quality in low- and middle-income countries is captured from the demographic and health surveys (DHS), which is based on the pregnant woman receiving a combination of ANC service components at any point or at least once during the pregnancy irrespective of the number of ANC visits. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 A recent scoping review has identified several input and process factors that influence the provision and utilization of optimum quality ANC services, including availability of trained workforce, commodities, guidelines, context-specific programs, that are essential to create enabling facility environment for quality ANC services. 23 Currently, there is a significant gap in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services that can provide specific guidance to improve quality of ANC services, and to address the equity gaps in access to quality ANC services.…”