Abstract
Antenatal care (ANC) reduces adverse health outcomes for both mother and baby during pregnancy and childbirth. The present study investigated the enablers and barriers to ANC service use among Indian women. The study used data on 183,091 women from the 2015–2016 India Demographic and Health Survey. Multivariate multinomial logistic regression models (using generalised linear latent and mixed models (GLLAMM) with the mlogit link and binomial family) that adjusted for clustering and sampling weights were used to investigate the association between the study factors and frequency of ANC service use. More than half (51.7%, 95% confidence interval (95% CI): 51.1–52.2%) of Indian women had four or more ANC visits, 31.7% (95% CI: 31.3–32.2%) had between one and three ANC visits, and 16.6% (95% CI: 16.3–17.0%) had no ANC visit. Higher household wealth status and parental education, belonging to other tribes or castes, a woman’s autonomy to visit the health facility, residence in Southern India, and exposure to the media were enablers of the recommended ANC (≥4) visits. In contrast, lower household wealth, a lack of a woman’s autonomy, and residence in East and Central India were barriers to appropriate ANC service use. Our study suggests that barriers to the recommended ANC service use in India can be amended by socioeconomic and health policy interventions, including improvements in education and social services, as well as community health education on the importance of ANC.
Highlights
Pregnancy and childbirth complications are the leading causes of maternal mortality worldwide, as an estimated 830 women lose their lives daily from preventable pregnancy- and/or childbirth-related causes
A little above half (51.7%, 95% confidence intervals (CIs): 51.1–52.2%) of Indian women had four or more Antenatal care (ANC) visits (Table 1)
A wide variation in the number of ANC visits was observed across Indian regions, as women who resided in the East reported the highest proportion of non-use of ANC services (39.3%, 95% CI: 38.2–40.6%), while those in the Northeast reported the lowest proportion of non-use of ANC services (2.9%, 95% CI: 2.7–3.2%)
Summary
Pregnancy and childbirth complications are the leading causes of maternal mortality worldwide, as an estimated 830 women lose their lives daily from preventable pregnancy- and/or childbirth-related causes. Over 99% of those maternal deaths occur in low- and middle-income countries (LMICs, including India) [1]. Antenatal care (ANC) provides a unique opportunity for screening and diagnosis, health promotion, and disease prevention among pregnant women, and their families and communities [2]. Appropriate utilisation of ANC services corresponds to improved maternal and newborn health, as well as a reduction in maternal deaths during pregnancy and childbirth [3,4,5]. Res. Public Health 2019, 16, 3152; doi:10.3390/ijerph16173152 www.mdpi.com/journal/ijerph
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