Abstract
ObjectiveTo propose an antenatal care classification for measuring the continuum of health care based on the concept of adequacy: timeliness of entry into antenatal care, number of antenatal care visits and key processes of care.MethodsIn a cross-sectional, retrospective study we used data from the Mexican National Health and Nutrition Survey (ENSANUT) in 2012. This contained self-reported information about antenatal care use by 6494 women during their last pregnancy ending in live birth. Antenatal care was considered to be adequate if a woman attended her first visit during the first trimester of pregnancy, made a minimum of four antenatal care visits and underwent at least seven of the eight recommended procedures during visits. We used multivariate ordinal logistic regression to identify correlates of adequate antenatal care and predicted coverage.FindingsBased on a population-weighted sample of 9 052 044, 98.4% of women received antenatal care during their last pregnancy, but only 71.5% (95% confidence interval, CI: 69.7 to 73.2) received maternal health care classified as adequate. Significant geographic differences in coverage of care were identified among states. The probability of receiving adequate antenatal care was higher among women of higher socioeconomic status, with more years of schooling and with health insurance.ConclusionWhile basic antenatal care coverage is high in Mexico, adequate care remains low. Efforts by health systems, governments and researchers to measure and improve antenatal care should adopt a more rigorous definition of care to include important elements of quality such as continuity and processes of care.
Highlights
Optimizing maternal and infant health requires, but is not limited to, the provision of available and accessible health care delivered by skilled health personnel throughout the antenatal period.[1]
Based on our previous research,[12] and drawing on population-based data from the most recent health and nutrition survey in Mexico, we propose an antenatal care classification that allows the continuum of services to be measured according to four dimensions of the health care process: access to care delivered by skilled health personnel that is timely, sufficient and with appropriate content
71.5% of women attended by skilled health personnel in Mexico received adequate antenatal care during their last pregnancy and the probabilities of receiving adequate care were higher among women with more years of schooling, health insurance and higher socioeconomic status
Summary
Optimizing maternal and infant health requires, but is not limited to, the provision of available and accessible health care delivered by skilled health personnel throughout the antenatal period.[1]. Any assessment of maternal care needs to be performed within the framework of human rights.[9] Strategies towards ending preventable maternal mortality are aimed at the achievement of millennium development goals (up to 2015) and sustainable development goals in the area of maternal mortality These goals seek to eliminate inequalities in access to health care and to ensure women receive universal coverage of sexual and reproductive health services that are responsive to women’s needs.[10]. The majority of studies including these indicators have measured coverage independently – reporting high average levels – but have failed to reflect the individual dimension of services provided (women who received comprehensive care and coverage in all indicators).[12,13,14]
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