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Only half of women worldwide receive the recommended amount of care during pregnancy

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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).

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.

Most pregnant women access skilled antenatal care at least once, but only 60 per cent receive the recommended minimum of four antenatal care visits
Percentage of women aged 15–49 attended at least once during pregnancy by skilled health personnel (ANC1) and percentage attended by any provider at least four times (ANC4), by region, LDCs and world, 2010–2015

* Excludes India, ** Estimate for ANC4 excludes China, ^ Excludes India and China (ANC4 only)

Notes: Estimates are based on a subset of countries with available data for the period 2010–2015. The ANC1 analysis includes 105 countries covering 67% of births worldwide not including India, and the ANC4 analysis includes 107 countries covering 57% of births worldwide, not including data for India and China for which estimates were not available for the specific time range. Estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for ANC4 for CEE/CIS..

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.

Urban women are far more likely than their rural counterparts to receive antenatal care
Percentage of women attended 4 or more times by any provider during pregnancy, by residential settings, 2000 and 2015

* Excludes India

** Excludes China

Source: UNICEF global databases 2015 based on from MICS, DHS and other nationally representative sources.

Note: Estimates for the year 2000 refer to an average of the period 2000-2009, estimates for the year 2015 refer to an average of the period 2010- 2015. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate a global average as well as regional average for CEE/CIS, Latin America and the Caribbean and Middle East and North Africa.

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.

Women in the richest quintile are more likely to receive antenatal care than those in the poorest quintile
Percentage of women attended at least once during pregnancy by skilled health personnel, by region and by wealth quintiles, 2010-2015

*Excludes India, ** Excludes China, ^Excludes India and China

Notes: Global estimates are based on a subset of 79 countries, covering more than 50% of global births (excluding China and India for which data was 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 CEE/CIS and Latin America and the Caribbean and South Asia.

Source:  UNICEF global databases 2015, from Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative sources.

REFERENCES

UNICEF, Progress for Children Beyond Averages: Learning from the MDGsNew 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: //data.unicef.org/maternal-health/antenatal-care#sthash.W01W4q5P.dpuf

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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.