Abstract
ObjectivesWe examined the utilisation, equity and determinants of full antenatal care (ANC), defined as 4 or more antenatal visits, at least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100 days, in India.MethodsWe analysed a sample of 190,898 women from India’s National Family Health Survey 4. Concentration curves and concentration index were used to assess equity in full ANC utilisation. Multivariable logistic regression model was used to examine the factors associated with full ANC utilisation.ResultsIn India, 21% of pregnant women utilised full ANC, ranging from 2.3–65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for atleast 100 days, and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste and maternal education. Registration of pregnancy, utilisation of government’s Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile(s), lack of father’s participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation.ConclusionsFull ANC utilisation in India was inadequate and inequitable. Although half of the women did not receive the minimum recommended ANC visits, the utilisation of TT immunisation was almost universal. The positive association of full ANC with ICDS utilisation and child’s father involvement may be leveraged for increasing the uptake of full ANC. Strategies to address the socio-demographic factors associated with low and inequitable utilisation of full ANC are imperative for strengthening India’s maternal health program.
Highlights
Antenatal care (ANC) is an opportunity to promote a positive pregnancy experience and improved maternal and child survival
The proportion of women who had a minimum of 4 ANC visits was 51.6%, ranging from 14.4–96.7% within states, iron folic acid (IFA) was consumed for a minimum of 100 days by 30.8% of women, ranging from 4.5– 85.5% within states
Lower wealth quintile(s), higher birth order, father not accompanying for the ANC visit, teenage pregnancy and unintended pregnancy were associated with lower odds of full ANC utilisation
Summary
Antenatal care (ANC) is an opportunity to promote a positive pregnancy experience and improved maternal and child survival. In India, the proportion of pregnant women receiving the minimum 4 antenatal visits has increased from 37.0 to 51.2% during 2006–2016 [8] This is relatively modest when compared to increase in the rate of institutional delivery which has doubled from 38.7 to 79% during the same time period, largely driven by the conditional cash transfer schemes of the government [8,9,10]. This differential coverage reflects a missed opportunity, as about one fourth of the maternal deaths are attributable to pre-eclampsia, eclampsia and antepartum haemorrhage, which could be identified and managed during the antenatal contacts [11]
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