Abstract
BackgroundA variety of antenatal care models have been implemented in low and middle-income countries over the past decades, as proposed by the World Health Organisation (WHO). One such model is the 2001 Focused Antenatal Care (FANC) programme. FANC recommended a minimum of four visits for women with uncomplicated pregnancies and emphasised quality of care to improve both maternal and neonatal outcomes. Malawi adopted FANC in 2003, however, up to now no study has been done to analyse the model’s performance with regards to antenatal care service quality and utilisation patterns.MethodsThe paper is based on data pooled from three comparable nationally representative Malawi Demographic and Health Survey (MDHS) datasets (2000, 2004 and 2010). The DHS collects data on demographics, socio-economic indicators, antenatal care, and the fertility history of reproductive women aged between 15 and 49. We pooled a sample of 8545 women who had a live birth in the last 5 years prior to each survey. We measure the impact of FANC on early access to care, underutilisation of care and quality of care with interrupted time series analysis. This method enables us to track changes in both levels and the trends of our outcome variables.ResultsWe find that FANC is associated with earlier access to care. However, it has also been associated with unintended increases in underutilisation. We see no change in the quality of ANC services.ConclusionIn light of the WHO 2016 ANC guidelines, which recommend an increase of visits to eight, these results are important. Given that we find underutilisation when the benchmark is set at four visits, eight visits are unlikely to be feasible in low-resource settings.
Highlights
A variety of antenatal care models have been implemented in low and middle-income countries over the past decades, as proposed by the World Health Organisation (WHO)
In 2010, annual monitoring results on the implementation of Focused Antenatal Care (FANC) showed that only one of the four central hospitals and four of the 24 district hospitals in Malawi met the WHO standards for delivering FANC [16]
The Conclusion In Malawi, the implementation of FANC has been associated with increased early access; it is associated with unintended consequences of underutilisation of antenatal care (ANC) services and no change in the overall quality of maternal health services
Summary
A variety of antenatal care models have been implemented in low and middle-income countries over the past decades, as proposed by the World Health Organisation (WHO) One such model is the 2001 Focused Antenatal Care (FANC) programme. A variety of antenatal care models have been implemented in low and middle-income countries over the past decades to improve maternal and child health outcomes, as proposed by the World Health Organisation (WHO) [1]. One such model is Focused Antenatal Care (FANC) programme. The four visits in the WHO FANC model are scheduled to be made at specific times as follows: the first visit should occur between 8 to 12 weeks after conception but not later than 16 weeks; and, a further three visits should occur between 24 and 38 weeks of gestation [2]
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