Abstract
BackgroundAntenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’.MethodsQuantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers.ResultsThe overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage.ConclusionThe coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits.
Highlights
Low up take of Antenatal care (ANC) is an important determinant of high maternal mortality rate in developing countries and is one of the basic components of maternal care on which the life of mothers and babies depend [1]
Multiple reasons have been reported for low coverage of ANC services that includes the weak health systems, inadequate training [5] and inaccessibility of health facilities and ANC services in Pakistan are widely cited as being responsible for a high proportion of maternal and infant deaths [6]
The study proposal was approved by National Bioethics Committee (NBC) Pakistan vide Ref No.487/09/NBC-36/RDC/7451 and the inception of the study was undertaken after the approval
Summary
Low up take of Antenatal care (ANC) is an important determinant of high maternal mortality rate in developing countries and is one of the basic components of maternal care on which the life of mothers and babies depend [1]. Ninety nine percent of these deaths occur in the developing countries The majority of these deaths could be avoided if women had access to quality medical care during pregnancy, childbirth and postpartum [2]. The ANC coverage in the Punjab province of Pakistan is only 53% and there isinequity in provision of ANC services to rural population as depicted by some studies which is 50% in comparison to 71% of urban women. Social developmental factors like education markedly influence the ANC coverage in low income countries for instance in a study in Ethiopia ANC utilization increases by skilled care providers as the level of education of woman increases. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’
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