Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013

Ann-Beth Moller,Max Petzold,Lale Say,Doris Chou

doi:10.1016/s2214-109x(17)30325-x

Ann-Beth Moller, Max Petzold + Show 2 more

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https://doi.org/10.1016/s2214-109x(17)30325-x

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Abstract

SummaryBackgroundThe timing of the first antenatal care visit is paramount for ensuring optimal health outcomes for women and children, and it is recommended that all pregnant women initiate antenatal care in the first trimester of pregnancy (early antenatal care visit). Systematic global analysis of early antenatal care visits has not been done previously. This study reports on regional and global estimates of the coverage of early antenatal care visits from 1990 to 2013.MethodsData were obtained from nationally representative surveys and national health information systems. Estimates of coverage of early antenatal care visits were generated with linear regression analysis and based on 516 logit-transformed observations from 132 countries. The model accounted for differences by data sources in reporting the cutoff for the early antenatal care visit.FindingsThe estimated worldwide coverage of early antenatal care visits increased from 40·9% (95% uncertainty interval [UI] 34·6–46·7) in 1990 to 58·6% (52·1–64·3) in 2013, corresponding to a 43·3% increase. Overall coverage in the developing regions was 48·1% (95% UI 43·4–52·4) in 2013 compared with 84·8% (81·6–87·7) in the developed regions. In 2013, the estimated coverage of early antenatal care visits was 24·0% (95% UI 21·7–26·5) in low-income countries compared with 81·9% (76·5–87·1) in high-income countries.InterpretationProgress in the coverage of early antenatal care visits has been achieved but coverage is still far from universal. Substantial inequity exists in coverage both within regions and between income groups. The absence of data in many countries is of concern and efforts should be made to collect and report coverage of early antenatal care visits to enable better monitoring and evaluation.FundingDepartment of Reproductive Health and Research, WHO and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Highlights

The health of women and children remains an unfinished agenda and a global challenge
The estimated worldwide coverage of early antenatal care visits increased from 40·9% (95% uncertainty interval [uncertainty intervals (UIs)] 34·6–46·7) in 1990 to 58·6% (52·1–64·3) in 2013, corresponding to a 43·3% increase
There has been a change in the pattern and type of obstetric outcomes, as a greater proportion of deaths and morbidities are related to complications of pre-existing medical conditions, namely indirect conditions, in a phenomenon described as the obstetric transition.[5]

Summary

Introduction

The health of women and children remains an unfinished agenda and a global challenge. Antenatal care is defined as the routine care of pregnant women provided between conception and the onset of labour. Antenatal care is an opportunity to provide care for prevention and management of existing and potential causes of maternal and newborn mortality and morbidity. The timing of initiation of the first antenatal care visit is paramount for ensuring optimal care and health outcomes for women and children. There has been a change in the pattern and type of obstetric outcomes, as a greater proportion of deaths and morbidities are related to complications of pre-existing medical conditions, namely indirect conditions, in a phenomenon described as the obstetric transition.[5]

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