The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Final boundary between the Republic of Sudan and the Republic of South Sudan has not yet been determined. *Dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu and Kashmir has not yet been agreed upon by the parties.
Only half of women worldwide receive the recommended amount of care during pregnancy
Global distribution of women attended at least four times during pregnancy by any provider, latest available data in the period 2010-2015
Source: UNICEF global databases, 2015, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative sources.
Note: The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations. Final boundary between the Republic of Sudan and the Republic of South Sudan has not yet been determined.
Globally, while 85 per cent of pregnant women access antenatal care with a skilled health personnel at least once, only six in ten (58 per cent) receive at least four antenatal visits. In regions with the highest rates of maternal mortality, such as sub-Saharan Africa and South Asia, even fewer women received at least four antenatal visits (49 per cent and 42 per cent, respectively).
ANTENATAL CARE IS ESSENTIAL FOR SAVING BABIES' AND MOTHERS' LIVES
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 all 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 of micronutrient supplementation, treatment of hypertension to prevent eclampsia, immunization against tetanus, HIV testing, in addition to 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 and sometimes deadly disease.
COVERAGE OF ANTENATAL CARE
Regional coverage of at least one antenatal care visit with skilled health personnel ranges from 69 per cent in South Asia (excluding India) to over 95 per cent in CEE/CIS, 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.
* Excludes India, ** Estimate for ANC4 excludes China, ^ Excludes India and China (ANC4 only)
Source: UNICEF Global databases 2016 based on DHS, MICS and other nationally representative sources.
Note: Estimates are based on a subset of countries with available data for the period 2010–2015. The ANC1 analysis includes 107 countries covering 78% of births worldwide, and the ANC4 analysis includes 119 countries covering 86% of births worldwide, not including data for India (ANC1) or China (ANC4) for which estimates were not available for ANC1 and ANC4 respectively. Estimates represent data from countries covering at least 50% of regional births.
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 and sub-Saharan Africa the urban-rural gap in coverage of four or more antenatal care visits exceeds 20 percentage points in favor of urban areas. This gap has not closed within the last decade.
Source: UNICEF global databases 2016, from Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative sources.
Note: Global estimates are based on a subset of 60 countries, covering 58 per cent of births in urban areas and 79 per cent in rural areas. Regional estimates represent data from countries covering at least 50% of regional births.
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 (excluding India), for instance, women in the richest quintile are five times as likely as women in the poorest quintile to receive four or more antenatal care visits, which is the minimum recommended (68 per cent versus 14 per cent). Large disparities in coverage based on wealth are also found in sub-Saharan Africa, particularly in West and Central Africa.
*Excludes India **Excludes China ^Excludes India and China
Source: UNICEF global databases 2016, based on DHS, MICS and other nationally representative sources.
Note: Global estimates are based on a subset of 80 countries, covering 63 per cent of global births (excluding China and India for which data by wealth were not available). Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for Latin America and the Caribbean.
UNICEF, Progress for Children Beyond Averages: Learning from the MDGs, New York, 2015
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 2016, UNICEF, New York, 2016.
UNICEF/WHO, Antenatal Care in Developing Countries: Promises, achievements and missed opportunities, WHO, Geneva, 2003.
WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015.
See more at: http://data.unicef.org/maternal-health/antenatal-care#sthash.W01W4q5P.dpuf
This summary presents new estimates of maternal mortality produced by the Maternal Mortality Estimation Inter-Agency Group (MMEIG) as part of global and country monitoring of the Millennium Development Goal five. The estimates for 1990 to 2015 presented in this summary are the eighth in a series of analyses by the MMEIG to examine global, regional and country progress in reducing maternal mortality.
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.
Millennium Development Goal
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.