Delayed initiation of antenatal care and its determinants in Ethiopia: A systematic review and meta-analysis.

There is a surge of poor maternal mental health (MMH)-related conditions leading to increased maternal mortality and morbidly in the United State(US), where 22.7% of cases were caused by preventable mental health conditions. Low-and medium-income countries (LMIC) are worst hit by this pandemic due to lack of information and few researches on maternal mental health issues. Lack of psychosocial education services leaves MMH issues, clouded by myths and misconceptions which deter women from seeking medical attention. The study objective was to determine the effects of knowledge on mental health among pregnant women using Edinburgh Postnatal Depression scale (EPDS). The aim was to determine the relationship between respondent’s level of knowledge of MMH and their mental health status. To achieve this, a cross-sectional study was conducted on n=130 women seeking antenatal care (ANC) services at Kiambu and Thika level 5 hospitals. Interviewer-administered questionnaire was used to gather data. Analysis was done using SPSS version 27. Results indicated that all respondents scored at least 50% in knowledge awareness; however, 43% of the respondent still screened positive for poor MMH, Chi-square distribution done indicated no statistical significance on respondents individual characteristics. In conclusion, Knowledge of MMH could reduce cases of poor MMH. It is therefore, recommended that an MMH education guide be provided by Ministry of Health Kenya and consistently delivered by trained primary caregivers for reliable results.

Effective coverage reflects the performance of a health system by integrating need, service utilization, and quality of care into a single measure. In many developing countries, inadequate effective coverage of antenatal care services along with poor quality maternal health services and low levels of awareness about healthcare has contributed to maternal mortality ratios that are 14 times higher than those in developed countries. Despite this significant disparity, there is limited evidence available regarding the effective coverage of antenatal care in Ethiopia. Therefore, this study aimed to assess the effective coverage of antenatal care and associated factors among women who attended antenatal care at West Gojjam Zone Public Hospitals, northwest Ethiopia. A facility-based retrospective cross-sectional study design was carried out in West Gojjam public hospitals from June 30 to July 30, 2023. Study participants were selected using a multi-stage simple random sampling technique using patient identification number as a sampling frame. Data were gathered from hospital health information data systems and client charts, entered into Epi data version 4.6, and then exported to SPSS statistical package version 25 for further analysis. Both bi-variable logistic regression and multi-variable logistic regression analyses were carried out. Variables with p-value <0.25 in the bi variable logistic regression were entered into multi-variable logistic regression. Variables having P-values <0.05 in the multi-variable logistic regression were considered as statistically significant predictors of the outcome variable. The effective coverage of antenatal care service was 25.9% (95% CI: 22.6, 29.4%) in the study area. Age of mothers ranged 25-34 (AOR: 0.32; 95% CI; 0.20-0.50), wanted pregnancy (AOR: 1.65; 95% CI; 1.08-2.55), presence of previous obstetric complication (AOR: 6.27; 95% CI; 3.83-10.28) and presence of previous gynecological complication (AOR: 2.08; 95% CI; 1.66-3.77) were statistically significantly associated variables with effective coverage of antenatal care services. In this study one out of four mothers received effective coverage of antenatal care in the study area. Age of mothers ranged from 25 to 34, wanted pregnancy, presence of previous obstetric complication and presence of previous gynecological complication were statistical significant predictors of effective coverage of antenatal service. Therefore, boosting effective antenatal care requires targeted interventions based on identified predictors.

Purpose Antenatal care (ANC) is a cornerstone of maternal and neonatal health, yet its utilization remains suboptimal in Somalia, contributing to high maternal and perinatal morbidity and mortality. Understanding the predictors of ANC utilization is essential for designing effective interventions. This systematic review aimed to identify predictors of antenatal care service utilization among women of reproductive age in Somalia. Materials and methods A systematic search of PubMed, Google Scholar, Medline, CINAHL, EMBASE, and African Journals Online was conducted for studies published between 2010 and 2025. Quantitative studies reporting predictors of ANC utilization using multivariable analysis were included. Study selection and reporting followed PRISMA guidelines. Methodological quality was assessed using standardized appraisal tools. The review protocol was registered in PROSPERO (registration number: CRD420251244002). Results Nine studies met the inclusion criteria. ANC utilization in Somalia was influenced by a combination of sociodemographic, obstetric, knowledge-related, and health system factors. Consistently reported predictors included maternal education, place of residence, household wealth index, marital status, pregnancy intention, maternal age, and exposure to mass media. Early gestational age at first visit, gravida status, knowledge of ANC, distance to health facilities, accessibility of services, and perceived health worker attitudes were also significant predictors. Conclusion Antenatal care utilization in Somalia is shaped by complex and interrelated individual, socioeconomic, and health system factors. Targeted interventions focusing on female education, community awareness, early ANC initiation, and improved access to quality maternal health services are critical to increasing ANC utilization and improving maternal and neonatal outcomes. Systematic Review Registration https://www.york.ac.uk/inst/crd , PROSPERO registration number, CRD420251244002.

According to global data from the World Health Organization (WHO), worldwide, approximately 10% of pregnant women and 13% of new mothers experience mental disorders, particularly depression. In developing countries, this figure is even higher, at 15.6% during pregnancy and 19.8% after childbirth. In severe cases, maternal distress can be so severe that they may even commit suicide. Furthermore, affected mothers are unable to function properly. As a result, child growth and development can also be impaired (WHO, 2023). The purpose of this study was to determine the relationship between family support and anxiety in third-trimester pregnant women facing childbirth at Dr. Sobirin Regional Hospital, Musi Rawas Regency in 2025.The study used a cross-sectional design. Data were collected by distributing questionnaires to 33 respondents, including pregnant women in their third trimester at Dr. Sobirin Regional Hospital, Musi Rawas Regency, using a total sampling technique. Univariate analysis revealed that more than half of the respondents, or 54.5%, were in the third trimester of pregnancy. Musi Rawas Regency in 2025 experienced poor family support, and more than half of respondents, or 57.6%, of third-trimester pregnant women, experienced high levels of anxiety during childbirth at Dr. Sobirin Regional General Hospital (RSUD) in Musi Rawas Regency in 2025. Bivariate analysis revealed a significant relationship between family support and third-trimester anxiety levels during childbirth at Dr. Sobirin Regional General Hospital (RSUD) in Musi Rawas Regency in 2025, with a p-value of 0.003.Dr. Sobirin Regional General Hospital (RSUD) in Musi Rawas Regency and related institutions should improve antenatal care services that focus not only on the physical aspects but also on the psychological aspects of pregnant women.

ABSTRACTBackground and AimsThe provision of quality service demands continuous monitoring and evaluation of ongoing service provision and improving organizational processes. Hence, the aims of this study were to assess facility readiness to provide quality of antenatal care and quality of antenatal care in public health facilities in southern Ethiopia.MethodsA health facility‐based cross‐sectional and retrospective studies were done in 2018. Multi‐stage sampling was used to select 131 facilities of different levels and 2237 records. To assess the quality of ANC, all three dimensions (number of visits, early initiation and services provided) were considered. Factors associated with getting ANC components were assessed by using multi‐level mixed effects linear regression.ResultsFrom the total health facilities assessed, only 47.3% had at least one HIV test kit, 30.5% had iron, 23.7% folic acid, and 51.9% had iron and folic acid combined. From hospitals and health centers, 77.1% had syphilis testing kits, and 34.3% could perform hemoglobin level tests. Of 1222 records with gestational period, only 15.5% started ANC at or before 16 weeks of gestation, and only 2.7% started at or before 12 weeks. On average, women in rural areas received 2.5% points lower ANC components than those in urban areas (p = 0.04). Compared to women attending at hospitals, women attending at health centers receive 5% fewer ANC components (p = 0.001) while those attending at health post receive 20% lower (p < 0.001) ANC components.ConclusionThe readiness of facilities to provide quality ANC was suboptimal, and clients' medical records demonstrated poor performance in all programmatic quality indicators. Women living in rural areas, women attending health centers, and health posts receive lower ANC components. Close monitoring of facility readiness and supporting service provision is vital to ensure the quality of the service.

ABSTRACTBackground and AimsUnderstanding the predictors of Tetanus Toxoid (TT) protection among women of reproductive age is essential for designing effective interventions to eliminate Maternal and Neonatal Tetanus (MNT) in Somaliland. This study aims to identify the sociodemographic, economic, and geographic determinants of TT protection.MethodsA cross‐sectional study was conducted using the 2020 Somaliland Demographic and Health Survey (SLDHS). Binary and multivariate logistic regression models, accounting for the complex survey design, were applied to identify determinants of TT protection (receipt of ≥ 2 doses) among 2630 women.ResultsSignificant predictors included Antenatal Care (ANC) attendance, education, wealth, and region. The adjusted odds of protection were over 8 times higher for women with 4 + ANC visits (AOR = 8.52; 95% CI: 6.31–11.51), nearly 3 times higher for the wealthiest women (AOR = 2.83; 95% CI: 1.98–4.05), and over 3 times higher for women with secondary or higher education (AOR = 3.48; 95% CI: 2.11–5.74).ConclusionFindings highlight the importance of strengthening ANC services as the primary platform for TT delivery. Tailored interventions are recommended to target the identified risk factors, including uneducated, poor, and rural women, particularly in underserved regions.

Potential antenatal care-mediated benefits of delivering maternal immunization in five low- and middle-income countries: a modeling analysis.

Scoping Review of Health Care-Seeking Behavior and Antenatal Care Visits Among Pregnant Adolescents in Low- and Middle-Income Countries.

Association between antenatal care service utilization and birth preparedness among Tanzanian pregnant women: A cross-sectional study.

Antenatal care (ANC) services play an important role in maintaining maternal and fetal health. However, the quality of services in primary healthcare facilities is still not optimal, and dissatisfaction among pregnant women has been identified, particularly in aspects of communication, empathy, and waiting time. Data from the Kementerian Kesehatan Republik Indonesia indicate that ANC visit coverage has not yet reached the expected targets over the past three years (Ministry of Health, 2022–2024). A preliminary study conducted at Puskesmas Pematang Kandis, Merangin Regency, also revealed complaints from pregnant women regarding inadequate information and limited attention from healthcare providers.This study aims to analyze the relationship between the quality of antenatal care services and the satisfaction of pregnant women at Puskesmas Pematang Kandis, Merangin Regency, in 2024. This study employed a quantitative analytical design with a cross-sectional approach. The population consisted of 328 pregnant women, with a sample of 77 respondents selected using purposive sampling, based on inclusion criteria of pregnant women who attended ANC visits and were willing to participate. Data were analyzed using univariate and bivariate analysis (Chi-Square test). The results showed a significant relationship between service quality dimensions, including tangibles (p=0.016), responsiveness (p=0.001), reliability (p=0.031), empathy (p=0.005), and assurance (p=0.003), and the satisfaction of pregnant women. In conclusion, the quality of antenatal care services is significantly associated with the satisfaction of pregnant women. It is recommended that Puskesmas Pematang Kandis improve service quality through effective communication training, enhancement of healthcare providers’ empathy, and improvement of service systems to reduce waiting time

This research conducted to determine the utilization of antenatal care services among pregnant women attending specialist hospital Bauchi state. Three research objectives and three research questions guided the study. Literature where review on effects of culture on ANC services, socio economic factors on utilization of ANC services and attitudes and health care services on the utilization of ANC services among pregnant women. The study adopted description research survey design and purposive sampling technique was used to select 90 patients from the study area. The instrument used for the data collection was structured questionnaire. 90 questionnaires were distributed to 90 respondents with the help of research assistance. The data collected was analyzed using frequency distribution table and percentage. Based on the research findings, it was revealed that cultural belief of different kind, low socio-economic status and attitude of healthcare providers are factors that influence the utilization of antenatal care services among pregnant women attending specialist hospital Bauchi. the findings the researcher recommended that the health care provider should help in educating the pregnant women on the need and importance of antenatal clinic attendance, culture and religious belief that can affect health negatively should be discouraged through community mobilization and participation towards factors that are harmful to health. Adequate provision of qualified health personnel to manage the health facilities and health unit should be fully equipped. finally, Government should do much within its limited resources to provide free ANC services at all level of health institutions and to all groups of pregnant women and Community religious, leaders should be involved in promoting ANC services.

Background/Objectives: Globally, momentum is building around antenatal multiple micronutrient supplementation (MMS), with evidence that it is as effective as iron-folic acid supplementation in preventing maternal anemia and more effective in improving birth outcomes. In line with the World Health Organization 2020 recommendation and as part of a broader implementation research project, this study examines MMS acceptability, pregnant women (PW)'s adherence practices and experiences, and facilitators and barriers to acceptability, adherence, and provision of MMS within public ANC services in Pakistan and Nigeria. Methods: Following introduction of MMS by the Government of Pakistan in April 2022 (Swabi District) and the Government of Nigeria in December 2023 (Bauchi State), mixed-methods research was conducted using cross-sectional surveys (one in each country), focus group discussions (6 in Pakistan, 9 in Nigeria), and in-depth interviews (7 in Pakistan, 10 in Nigeria) with PW, family members, and facility- and community-based healthcare providers (HCPs). Results: Findings in both settings showed that MMS is widely accepted, and almost all women (>97%) started consuming the MMS they received. Adherence levels, assessed using both pill-count and self-reported measures, exceeded 70%. In both countries, perceived benefits were identified as a key enabler to MMS acceptability and adherence among PW, whereas perceived negative effects acted as a barrier. Facilitators of MMS provision included trusting relationships between PW and HCPs, while delayed antenatal care (ANC) initiation, anemia screening, and limited agency of PW were identified as barriers. Conclusions: This study provides findings to inform MMS scale-up across public ANC platforms in two low- and middle-income countries and contributes to global evidence on context-specific considerations for MMS implementation.

Increasing high temperatures, severe drought, altered rainfall patterns, and floods weaken essential infrastructure and services, increase risk of diseases, and disrupt women’s access to antenatal care. In Kenya, 2024 was the hottest on record with above normal rainfall, resulting in prolonged flooding. This paper describes the influence of adverse weather patterns on access to antenatal care in Kisumu and Migori Counties, adjacent to Lake Victoria. Qualitative data were primarily collected through focus group discussions (n = 16) with women aged 15–24 years (n = 62 participants) or 25–49 years (n = 87 participants), who had given birth in the last two years. Most participants recognize prolonged shifts in weather patterns, including unpredictability of rainfall, heavy rainfall and floods, prolonged dry spells, and rising temperatures which are increasingly affecting their daily lives. This includes damaged crops, loss of livelihood, financial challenges with food prices escalating, lack of safe drinking water, homes destroyed and loss of effects (due to flooding). Others reported how roads and bridges get washed away preventing women from accessing health care services resulting in poor uptake of antenatal care services. Climate change presents a complex and significant threat for vulnerable groups such as pregnant women. Mitigation strategies must focus on integrating women’s voices in climate-health policies to ensure continued access to healthcare, and reduce adverse health outcomes associated with climate change.

Male partner involvement in antenatal care is crucial for improving maternal and neonatal outcomes, yet participation remains limited in many parts of India, with context-specific evidence still limited. To address this gap, the present study was conducted to examine barriers to men’s involvement in antenatal care and to identify factors associated with their participation in the Sonipat district of Haryana, India. A convergent parallel mixed-method design was employed. Quantitative data were collected from 260 women using a semi-structured schedule, and qualitative data were gathered through six focus group discussions with male participants. After taking written informed consent, all the participants were interviewed using a predesigned, pretested semi-structured schedule for desired information, and a FGD guide was used to collect qualitative data. The study found that 80.8% of male partners were involved in antenatal care among 260 participants. Higher male involvement was noted among women with postgraduate education. Male participation was significantly higher in planned pregnancies (87.1%) compared to unplanned ones (36.1%). Focus group discussions revealed barriers such as negative healthcare provider attitudes, economic constraints, and cultural norms. The study demonstrates a higher male involvement in antenatal care than some prior reports from India. However, several sociocultural and systemic barriers persist. To enhance male participation, it is imperative to address these challenges through targeted interventions, such as improving healthcare provider attitudes, reducing financial burdens, and implementing policies that support paternity leave.

Background Maternal and perinatal health remain critical public health priorities and significantly contribute to the global disease burden. Severe maternal morbidity (SMM) is a key determinant of adverse outcomes for both mothers and newborns. Early detection and effective management of maternal complications are vital for improving outcomes, and high-quality antenatal care (ANC) is strongly associated with reduced maternal and perinatal morbidity and mortality. In Tanzania, new ANC guidelines have been in effect since 2020; however, little is known about their implementation, particularly from the perspectives of nurses and midwives, who provide over 80% of ANC services. This study explored their perspectives in public, urban health facilities in Dar es Salaam. Methods A descriptive qualitative study was conducted among nurses and midwives working in four Reproductive and Child Health (RCH) clinics in Dar es Salaam, purposively selected. Data were collected from May 6th to June 28th, 2024, using focus group discussions (FGDs) and analyzed using thematic analysis. Results A total of 29 nurses and midwives participated in five FGDs. The study revealed three themes: (a) the usefulness of the new ANC guidelines, including reduction of maternal and perinatal mortality, improvement in maternal and perinatal health outcomes, and enhancement of ANC service delivery and providers’ proficiency, (b) facilitators of the new ANC guidelines utilization, including health system-related factors and provider-related factors, and (c) challenges to the utilization of the new ANC guidelines, encompassing health system-related barriers, healthcare providers (HCPs)-related barriers, and client-related barriers. Conclusion HCPs viewed the new ANC guidelines as beneficial for improving maternal and perinatal outcomes, service delivery, and provider competence. However, implementation was hindered by systemic barriers, including staffing shortages, inadequate supplies, limited training, provider-related challenges, and client financial constraints. Implementing targeted interventions is crucial to effectively address these challenges.

Smokeless tobacco (SLT) use during pregnancy remains a significant yet underrecognized public health concern, particularly in low- and middle-income countries. Despite its wide prevalence and potential for adverse maternal and foetal outcomes, SLT has received comparatively less attention than smoking in prenatal health initiatives. This systematic review and meta-analysis aimed to estimate the global and regional prevalence of SLT use among pregnant women and examine associated sociodemographic patterns. We systematically searched PubMed, Embase, Scopus, and regional databases for studies reporting the prevalence of SLT use during pregnancy up to 31 January 2025. Cross-sectional, cohort, and survey-based studies were eligible for inclusion. Two reviewers independently screened articles, extracted data, and assessed study quality. Pooled prevalence estimates were calculated using a random-effects meta-analysis model due to anticipated heterogeneity. Subgroup analyses were conducted based on geography, rural versus urban setting, and education level. Thirty-four studies encompassing data from over 9 509 590 pregnant women across Asia, Africa, Europe, North America, and Oceania were included. The pooled prevalence of SLT use during pregnancy was 8% (95% CI: 7%-10%), with a significant heterogeneity (I2 = 100%, P < .001), indicating substantial variation across studies. There was a wide regional variation, from <1% in Scandinavian countries to >60% in rural Indonesia and Palau. Higher prevalence was consistently observed among women from lower socioeconomic backgrounds, with limited education, and residing in rural settings. Cultural normalization and habitual use were common reasons for SLT use in these populations. SLT use during pregnancy is prevalent in several parts of the world, especially among socioeconomically disadvantaged populations. These findings underscore the urgent need for targeted tobacco control interventions, maternal health education, and region-specific policy strategies addressing SLT use during pregnancy. Increased awareness, regulatory action, and integration of SLT screening in antenatal care services are warranted.

Children who have never received any vaccination represent one of the clearest markers of health system inequity. In this study, unvaccinated status was defined as caregiver report that a child under five years had never received any routine vaccine, reflecting complete non-vaccination rather than dose-specific (e.g., DTP1-based) definitions. This study examined the prevalence and determinants of unvaccinated children in Somaliland using nationally representative data. We analyzed data from 1,104 children under five years from the 2020 Somaliland Health and Demographic Survey (SLHDS). Multilevel logistic regression models were fitted to assess individual-, household-, and community-level factors associated with being unvaccinated. The prevalence of unvaccinated children was 79.9%. In the fully adjusted model, children of mothers with secondary education had significantly lower odds of being unvaccinated compared with those whose mothers had no education (AOR = 0.32; 95% CI: 0.14–0.74). Antenatal care attendance was strongly associated with reduced odds of non-vaccination (1–3 visits: AOR = 0.37; 95% CI: 0.28–0.52; ≥4 visits: AOR = 0.40; 95% CI: 0.26–0.64). Older children were less likely to be unvaccinated compared to infants aged 0–8 months (9–23 months: AOR = 0.37; 95% CI: 0.19–0.72; 24–59 months: AOR = 0.32; 95% CI: 0.19–0.58). Children not currently breastfeeding had lower odds of being unvaccinated (AOR = 0.68; 95% CI: 0.52–0.90). At the community level, residence in areas with high ANC utilization was associated with substantially lower odds of non-vaccination (AOR = 0.37; 95% CI: 0.25–0.57). Descriptive mapping revealed marked regional variation, with particularly high prevalence observed in Awdal and Sool. Complete non-vaccination in Somaliland is strongly associated with maternal education, engagement with antenatal care, child age, breastfeeding status, and community-level health service utilization. Integrated maternal–child health strategies and targeted regional interventions are urgently needed to reduce the exceptionally high burden of unvaccinated children.

Background: Antenatal care (ANC) is essential for promoting the health and well-being of mothers and their babies. Despite ongoing global efforts, ANC uptake remains below optimal levels in many parts of Nigeria. This study assessed the attitudes of pregnant women toward midwives and how these attitudes influence their use of ANC services in the Utan community, attending selected health centres in Jos North Local Government Area, Plateau State. A descriptive cross-sectional survey was carried out among 73 pregnant women aged 18 years and above. A structured questionnaire was used to collect from the participants who were selected through a multistage random sampling by first stratifying them into separate streets and using simple balloting to select a proportionate sample from each stratum, and the collected data were analyzed using SPSS version 27 at significant level of 0.05. Findings showed that most women expressed positive attitudes toward midwives, with 72.6% strongly agreeing that professional competence was the most important factor influencing their perception. ANC utilization was generally encouraging: 42.5% strongly agreed that they attended appointments regularly, and 41.1% reported that they consistently followed advice from midwives and attended routine health checks. Access to necessary tests and screenings was confirmed by 37.0% of respondents. However, only 23.3% strongly agreed that the ANC services they received fully met their needs, indicating gaps in service adequacy. Economic challenges (54%), transportation difficulties (57%), and long distances to health facilities (41%) were identified as major barriers to ANC utilization. There was no significant relationship between attitudes toward midwives and ANC use (X2 (Exact Test) = 2.749, df= 2, p= 0.239). Though pregnant women in the Utan community had a positive view towards midwives, financial and logistic barriers hinder their ANC attendance. There should be an Improved ANC services, expanded access, and an improved maternal health outcome at community level.

Low birth weight (LBW), defined as a birth weight of less than 2500 g, remains a major public health concern worldwide. Approximately 15–20% of all live births globally are affected, representing more than 20 million newborns each year, with the vast majority occurring in low- and middle-income countries. LBW is associated with increased risks of neonatal morbidity, mortality, impaired growth, and long-term developmental complications. Despite ongoing maternal and newborn health interventions in Ethiopia, determinants of LBW among term singleton neonates remain insufficiently explored. Therefore, this study aimed to identify factors associated with low birth weight among term singleton neonates delivered in public health facilities of Bahir Dar City, Ethiopia. An institution-based unmatched case–control study was conducted from June 1 to August 30, 2020, in public health facilities of Bahir Dar city, Ethiopia. Cases were consecutive live-born term singleton neonates weighing less than 2500 g, while controls were the next two live-born term singleton neonates weighing 2500 g or more delivered at the same facilities. Data were collected using a structured interviewer-administered questionnaire and medical record review. Data were entered and analyzed using statistical software. Bivariate logistic regression analysis was conducted to identify candidate variables, and crude odds ratios (CORs) with 95% confidence intervals (CIs) were computed. Variables eligible for inclusion were subsequently entered into a multivariable logistic regression model to identify independent determinants of low birth weight, with adjusted odds ratios (AORs) and 95% CIs reported. Most study mothers (85.3%) were aged 21–34 years. In multivariable analysis, being a housewife (AOR = 3.87; 95% CI: 1.01–14.8), primiparity (AOR = 4.12; 95% CI: 1.87–9.05), pregnancy-induced hypertension (AOR = 4.69; 95% CI: 1.32–16.74), unwanted pregnancy (AOR = 3.80; 95% CI: 1.11–12.92), and not taking additional food during the current pregnancy (AOR = 3.09; 95% CI: 1.37–6.99) were significantly associated with low birth weight. Low birth weight among term singleton neonates in Bahir Dar city was significantly associated with maternal, obstetric, and socioeconomic factors. Primiparity, pregnancy-induced hypertension, unwanted pregnancy, lack of additional dietary intake during pregnancy, and maternal occupation as a housewife were the main determinants. Strengthening antenatal care services with a focus on nutritional counseling, pregnancy planning, and early detection and management of hypertensive disorders may help reduce the burden of low birth weight.