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Current Status + Progress
Only half of women worldwide receive the recommended amount of care during pregnancy

Regular contact with a doctor, nurse or midwife during pregnancy allows women to receive services vital to their health and that of their future children. The World Health Organization (WHO) recommends a minimum of four antenatal care visits. However, global estimates indicate that only about half of pregnant women receive this recommended amount of care.

Antenatal care can help women prepare for delivery and understand warning signs during pregnancy and childbirth. It can be a source for micronutrient supplementation, treatment of hypertension to prevent eclampsia, immunization against tetanus, HIV testing and medications to prevent mother-to-child transmission of HIV in cases of HIV-positive pregnant women. In areas where malaria is endemic, health personnel can also provide pregnant women with medications and insecticide-treated mosquito nets to help prevent this debilitating, sometimes deadly, disease. 

COVERAGE OF ANTENATAL CARE

According to the latest estimates, coverage of antenatal care (at least one visit with a doctor, nurse or midwife during pregnancy) increased from 65 per cent to 83 per cent globally from 1990 to 2013. Regional averages range from 71 per cent in South Asia to over 90 per cent in East Asia and the Pacific and Latin America and the Caribbean, although disparities are common within and among countries. In viewing the data, it is important to remember that these percentages bear no reflection on either the skill level of the health-care provider or the quality of care, both of which can influence whether such care actually succeeds in bringing about improved maternal and newborn health.

Most women have contact with a skilled health-care provider at least once during pregnancy
Percentage of women attended at least once during pregnancy by skilled health personnel (doctor, nurse or midwife), by region, 2008─2012

Notes: Global estimates are based on a subset of 107 countries, covering 80 per cent of births worldwide. Regional estimates represent data from countries covering at least 50 per cent of regional births. Data coverage was insufficient to calculate the regional average for Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS).

Sources: UNICEF global databases, 2014, based on MICS, DHS and other nationally representative sources. 
 

DISPARITIES IN COVERAGE

Although overall levels of antenatal care are relatively high across regions, disparities are revealed when coverage is examined in light of household wealth and urban or rural residence. In South Asia, sub-Saharan Africa, and the Middle East and North Africa, the urban-rural gap in coverage (at least one visit with a skilled provider) exceeds or approaches 20 percentage points in favour of urban areas.

Urban women are far more likely than their rural counterparts to receive antenatal care
Percentage of women attended at least once during pregnancy by skilled health personnel (doctor, nurse or midwife), by region and by urban or rural residence, 2008─2012

* Excludes China.

Notes: Global estimates are based on a subset of 86 countries, covering 52 per cent of births in urban areas and 73 per cent of births in rural areas worldwide (excluding China, for which data are unavailable). Regional estimates represent data from countries covering at least 50 per cent of regional births. Data coverage was insufficient to calculate the regional averages for CEE/CIS and Latin America and the Caribbean.

Source:  UNICEF global databases, 2014, based on MICS, DHS and other nationally representative sources. 
 

Globally, women in the richest 20 per cent of the population are also more likely to receive antenatal care than poorer women, especially in the most deprived regions. In South Asia, for instance, women in the richest quintile are almost twice as likely as women in the poorest quintile to have at least one antenatal care visit with a skilled provider (95 per cent versus 50 per cent). Large disparities in coverage based on wealth are also found in sub-Saharan Africa.

Household wealth is also associated with higher levels of antenatal care
Percentage of women attended at least once during pregnancy by skilled health personnel (doctor, nurse or midwife), by region and by wealth quintiles, 2008─2012

* Excludes China.

Notes: Global estimates are based on a subset of 69 countries, covering 56 per cent of births worldwide (excluding China, for which data are unavailable). Regional estimates represent data from countries covering at least 50 per cent of regional births. Data coverage was insufficient to calculate the regional averages for CEE/CIS, Latin America and the Caribbean and the Middle East and North Africa. 

Source:  UNICEF global databases, 2014, based on MICS, DHS and other nationally representative sources. 

Globally, only half of pregnant women receive at least four antenatal visits – the recommended minimum. In regions with the highest rates of maternal mortality, such as sub-Saharan Africa and South Asia, coverage of this important intervention is below 50 per cent (48 per cent and 35 per cent, respectively).

Wide disparities are found among regions in the proportion of women receiving the recommended number of antenatal care visits
Percentage of women attended at least four times during pregnancy by any provider, by region, 2008─2012

* Excludes China.

Notes:  Global estimates are based on a subset of 81 countries, covering 62 per cent of births worldwide (excluding China, for which data are unavailable). Regional estimates represent data from countries covering at least 50 per cent of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS.
Sources: UNICEF global databases, 2014, based on MICS, DHS and other nationally representative sources.
 

REFERENCES

UNICEF, Progress for Children: A report card on maternal mortality, Report No. 7, UNICEF, New York, 2008.

UNICEF, The State of the World’s Children 2014, UNICEF, New York, 2014.

UNICEF/WHO, Antenatal Care in Developing Countries: Promises, achievements and missed opportunities, WHO, Geneva, 2003.

Access The Data
Antenatal Care Coverage
Antenatal care coverage - at least one visit with skilled health personnel Download Data
Antenatal care coverage - at least four visits Download Data
Notes on the Data

UNICEF – in collaboration with the World Health Organization (WHO) – is the UN organization responsible for monitoring and reporting on indicators in antenatal care coverage: at least one visit with a skilled health provider and at least four visits with any provider. Both are official indicators for MDG 5: Improve maternal health.

 

MDG indicator

Millennium Development Goal

Target

 

5.5 Antenatal care coverage (at least one visit with a skilled provider)

 

Antenatal care coverage (at least four visits with any provider)

Goal 5. Improve maternal health

Target 5.B: Achieve, by 2015, universal access to reproductive health

 

DEFINITION OF INDICATORS

Antenatal care coverage (at least one visit) is the percentage of women aged 15 to 49 with a live birth in a given time period that received antenatal care provided by skilled health personnel (doctor, nurse or midwife) at least once during pregnancy.

Skilled health personnel refers to workers/attendants that are accredited health professionals – such as a midwife, doctor or nurse – who have been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns. Both trained and untrained traditional birth attendants are excluded.

Antenatal care coverage (at least four visits) is the percentage of women aged 15 to 49 with a live birth in a given time period that received antenatal care four or more times. Available survey data on this indicator usually do not specify the type of the provider; therefore, in general, receipt of care by any provider is measured.

Antenatal visits present opportunities for reaching pregnant women with interventions that may be vital to their health and well-being and that of their infants. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content of antenatal care visits, which should include:

·         blood pressure measurement

·         urine testing for bacteriuria and proteinuria

·         blood testing to detect syphilis and severe anaemia

·         weight/height measurement (optional).

Measurement limitations.  Receiving antenatal care during pregnancy does not guarantee the receipt of interventions that are effective in improving maternal health. Receiving antenatal care at least four times, which is recommended by WHO, increases the likelihood of receiving effective maternal health interventions during antenatal visits. Importantly, although the indicator for ‘at least one visit’ refers to visits with skilled health providers (doctor, nurse or midwife), ‘four or more visits’ refers to visits with any provider, since standardized global national-level household survey programmes do not collect provider data for each visit. In addition, standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries.