Abstract
BackgroundMaternity care services provide critical interventions aimed at improving maternal and newborn health. In this study, we examined determinants of antenatal care (ANC) content in Syria, together with changes over time.MethodsWe analysed two national surveys conducted by the Central Bureau of Statistics in Damascus (PAPFAM 2001 and MICS 2006). Findings of this initial analysis led to a qualitative study on adequacy of antenatal care content in two Syrian governorates, Aleppo and Latakia in 2010, which in turn informed further quantitative analysis. The perspectives and practices of doctors, women, midwives and health officials were explored using in-depth interviews. A framework approach was used to analyse the data.ResultsThe quantitative analysis demonstrated that women’s education level, the type of health facility they attended and whether they had experienced health complications were important determinants of adequacy of ANC content received. The qualitative study revealed that additional factors related to supply side and demand side factors (e.g. organization of health services, doctors' selective prescription of ANC tests and women's selective uptake of those tests), influenced the quality of ANC and explained some regional differences between Aleppo and Latakia.ConclusionsThe percentage of women who received adequate ANC content was probably higher in Latakia than in Aleppo because women in Latakia were more educated, and because services were more available, accessible, and acceptable to them.
Highlights
Antenatal care (ANC) can detect and treat problems of pregnancy, and increase women’s chances of having a skilled attendant at birth and of seeking care promptly should complications occur [1]
The percentage of women who received adequate antenatal care (ANC) content was probably higher in Latakia than in Aleppo because women in Latakia were more educated, and because services were more available, accessible, and acceptable to them
In Syria in 2004–6, 85% of women had at least one ANC visit, our analyses showed that only 54% of women who attended ANC, had adequate content of ANC, and that levels of adequate content varied dramatically by governorate (42% in Aleppo compared to 93% in Latakia)
Summary
Antenatal care (ANC) can detect and treat problems of pregnancy, and increase women’s chances of having a skilled attendant at birth and of seeking care promptly should complications occur [1]. In the Millennium Development Goal 5 (MDG5) era, (aimed at improving maternal health between 1990 and 2015), the World Health Organization (WHO) recommended four focussed ANC visits to ensure such interventions were delivered [6]. The most studied ANC outcome is whether women attended ANC or not (coverage), and to a lesser extent, the trimester of initiation and the frequency of visits. Few studies have examined the content of care This picture continues with the indictors for the Sustainable Development Goals (SDGs), (a subset of the heath goal being aimed at reducing maternal and neonatal mortality by 2030). WHO issued new ANC guidelines recommending initiation of ANC in the first trimester of pregnancy and minimum of 8 visits [7]. We examined determinants of antenatal care (ANC) content in Syria, together with changes over time
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