Abstract
BackgroundEgypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC). The objective of this paper is to describe the changes over time (1991–2014) in the use of ANC in Egypt, focusing on sector of provision (public versus private), and the content and equity of this care, to inform future policies for improving maternal and newborn health.MethodsWe used Demographic and Health surveys (DHS) conducted in Egypt in 1995, 2000, 2005, 2008 and 2014 to explore national and regional trends in ANC. To assess content of care, we calculated the percentage of ANC users who reported receiving seven ANC components measured in DHS in 2014.ResultsDuring the period under consideration, the percentage of women in need of ANC who received facility-based ANC increased from 42 to 90%, the majority of which was private-sector ANC. The mean number of ANC visits among ANC users increased over time from 7.5 (95% confidence interval [CI] = 7.1–7.9) in 1991–1995 to 9.7 (95%CI 9.6–9.9) in 2010–2014. In 2010–2014, 44% of women using public ANC reported eight or more visits compared to 71% in private ANC. In the same period, 24% of ANC users received all seven care components. This percentage ranged from 10% of women reporting fewer than four ANC visits to 29% of women reporting eight or more. The poorest ANC users received all seven measured components of care less often than the wealthiest (20% versus 28%, p-value< 0.001).ConclusionsEgypt’s improvements in ANC coverage were characterized by decreasing reliance on public services and a rising number of ANC visits. However, despite rising ANC coverage, less than a third of women received the seven essential ANC components measured at least once during pregnancy, with differences between poorer and wealthier women. Policymakers need to ensure that high ANC coverage translates into equity-focused interventions targeting ANC quality. Further research needs to support this effort by assessing the determinants behind poor quality of ANC and evaluating potential interventions.
Highlights
Egypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC)
The objective of this paper is to describe the changes over time in the use of ANC in Egypt, focusing on the sector of provision, and the content and equity of ANC, nationally and by region, in order to inform future policies
The mean number of ANC visits during pregnancy among ANC users increased over time (Fig. 2) from 7.5 (95% confidence interval [CI] = 7.1–7.9) in 1991–1995 to 9.7 (95%CI 9.6–9.9) in 2010–2014
Summary
Egypt has seen substantial decreases in maternal mortality and reached near universal coverage for antenatal care (ANC). In addition to increasing the recommended number of ANC contacts from a minimum of four to eight, this recommendation highlighted the importance of quality of care received by women during pregnancy Following this recommendation, global attention has been shifting from predominantly measuring utilisation (coverage) of ANC to additional considerations of equity and quality of this care in order to tackle remaining preventable morbidity and mortality among women and their babies [10,11,12,13]. In the last three decades, Egypt has seen substantial improvements in maternal survival: a decrease in maternal mortality from 174 per 100,000 live births in 1992–3 [14] to a level of around 33–42 per 100,000 live births by 2015 [15, 16] This progress was achieved through various strategies to increase utilisation of care, such as provider training, introduction of standards of care, facility upgrades and public awareness campaigns. ANC is important as a vehicle for communicating information about complications of pregnancy and delivery, and discussing birth preparedness in general
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