Abstract
BackgroundInadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. Although ANC coverage is relatively high in Brazil, there are revealed some health disparities when coverage is examined by socio-demographic determinants. In this study we evaluated ANC quality and its socio-demographic determinants using data from the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil.MethodsThis study is part of the 2015 Pelotas population-based birth cohort (n = 3923 pregnant women) conducted in southern Brazil. ANC quality was assessed through 19 content and service utilization indicators recommended by the Brazilian Ministry of Health. Descriptive analyses and associations of each of the ANC indicators and independent variables were performed using the chi-square and linear trend test. ANC indicators were analyzed individually and aggregated as a score. Associations between ANC score quality and socio-demographic variables were assessed with ordinal regressions. Mediation analysis with G-computation was performed to estimate direct and indirect effect of mother’s level of education on ANC quality mediated by the number of consultations and timing of ANC initiation. Base and post confounders were included.ResultsThe results showed that except for breast examination, height measurement, tetanus toxoid vaccination and ANC starting at the first trimester, all ANC indicators showed more than 80% coverage during ANC visits.In the adjusted analysis, inadequate quality ANC was associated with lower maternal education level, not having a partner, being multiparous, being attended by a private provider and by the same professional in all consultations. In the mediation analyses, 6.8% of the association between ANC quality and mother’s education was mediated by the trimester in which ANC started, while 12.8% was mediated by the number of ANC visits.ConclusionsANC quality is associated with pregnant women’s socio-demographic characteristics. Significant efforts are needed to improve the quality of facility-based maternity care.
Highlights
Inadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes
Specific patterns of ANC indicators and their sociodemographic determinants When we evaluated the associations of each ANC indicator individually and studied the determinants, it was generally observed that women with higher sociodemographic vulnerabilities had a significantly lower proportion of ANC indicators than the rest
Socio-demographic determinants of ANC quality assessed using a score We examined the relationship between sociodemographic determinants and ANC quality, defined in this paper by combining key components performed during ANC
Summary
Inadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. The different models of ANC routines (appropriate time to start consultations, periodicity, and the content of care) have been the subject of constant analysis due to the variability in practice across countries over time, especially in trying to set necessary minimum standards that are cost-effective to prevent maternal and child morbidity and mortality [2] From this perspective, WHO has been developing initiatives to evaluate the effectiveness of different types of maternal health care models by proposing minimum packages for ANC [3] and has recently issued new comprehensive recommendations on routine ANC that have universal components applicable to all women. Regarding the frequency of visits, the new guideline recommends a minimum of eight during pregnancy, emphasizing the importance of high-quality care during each contact, providing the proven effective procedures and interventions at each visit, and expanding the definition of ANC quality by considering content, service utilization and delivery indicators [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
