Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam

Toan K Tran,Karin Gottvall,Max Petzold,Hinh D Nguyen,Henry Ascher

doi:10.1186/1472-6963-12-40

Abstract

BackgroundAntenatal Care (ANC) is universally considered important for women and children. This study aims to identify factors, demographic, social and economic, possibly associated with three ANC indicators: number of visits, timing of visits and content of services. The aim is also to compare the patterns of association of such factors between one rural and one urban context in northern Vietnam.MethodsTotally 2,132 pregnant women were followed from identification of pregnancy until birth in two Health and Demographic Surveillance Sites (HDSS). Information was obtained through quarterly face to face interviews.ResultsLiving in the rural area was significantly associated with lower adequate use of ANC compared to living in the urban area, both regarding quantity (number and timing of visits) and content. Low education, living in poor households and exclusively using private sector ANC in both sites and self employment, becoming pregnant before 25 years of age and living in poor communities in the rural area turned out to increase the risk for overall inadequate ANC. High risk pregnancy could not be demonstrated to be associated with ANC adequacy in either site. The medical content of services offered was often inadequate, in relation to the national recommendations, especially in the private sector.ConclusionLow education, low economic status, exclusive use of private ANC and living in rural areas were main factors associated with risk for overall inadequate ANC use as related to the national recommendations. Therefore, interventions focussing on poor and less educated women, especially in rural areas should be prioritized. They should focus the importance of early attendance of ANC and sufficient use of core services. Financial support for poor and near poor women should be considered. Providers of ANC should be educated and otherwise influenced to provide sufficient core services. Adherence to ANC content guidelines must be improved through enhanced supervision, particularly in the private sector.

Highlights

Antenatal Care (ANC) is universally considered important for women and children
Rural-urban difference in adequate use of ANC Only one study, to our knowledge, of ANC adequacy and related factors in Vietnam, that combines the number of visits, the timing of ANC visits and ANC service content and that apply theoretical models for the selection and analysis of factors has been conducted [15,16]
Total number of visits, time for first visit and specific services received during the ANC visits, this study gives a more detailed picture of ANC adequacy and its associations to selected factors in the urban and rural areas

Summary

Introduction

Antenatal Care (ANC) is universally considered important for women and children. About 98% of these occur in low and middle income countries [1]. Many studies have been conducted to examine factors related to the utilization of ANC in middle and low income countries [4,5,6]. Household income, parity, women’s age and occupation, cost and availability of services are factors commonly correlated to the use of ANC in these studies [7]. The place of residence, urban or rural area, is a factor affecting the use of ANC. Some studies have shown differences between the urban and rural areas in knowledge, attitude and practices of women towards antenatal care [8,9]

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