Antenatal care reborn? Healthcare for pregnant women in developing countries

Antenatal care is important for identifying and responding to risk factors in pregnancy. But do mothers in the developing world receive adequate and appropriate antenatal care? Researchers from the Population Council and the UK University of Southampton investigated antenatal services in Kenya.

Use of antenatal care is associated with a variety of socio-economic, cultural and reproductive factors, they found. Accessibility of healthcare facilities also influences their use by pregnant women. It is important to identify and target groups of women who do not use health services in pregnancy and who might be at high risk of adverse outcomes.

Lack of antenatal care can increase the chance of serious problems in pregnancy and is linked to maternal mortality, perinatal deaths, low birth weight and premature delivery. Regular antenatal care is important for:

• identifying women at increased risk of adverse pregnancy outcomes
• establishing good relations between women and their healthcare providers
• encouraging women to seek trained assistance at delivery
• providing tetanus immunisations, malaria prophylaxis, iron and folic acid tablets, and nutrition education.

Many developing countries have adopted an antenatal care programme that was recommended by the UK government more than 70 years ago. This generally involves a first visit during the third month of pregnancy and a total of 12 or 13 appointments. Visits consist of a medical history and examination and may include laboratory analysis such as syphilis testing and blood group typing. But is this the best programme of antenatal care for developing countries?

This study uses data from the 1993 Kenya Demographic and Health Survey to investigate the variations in the use of antenatal services in Kenya. It showed that the majority of pregnant women (82 percent) receive between 2 and 6 antenatal visits. A greater total number of appointments and an earlier first visit are associated with:

• higher household socio-economic status
• desire for a small family
• previous use of modern contraceptive methods
• planned pregnancy.

Access to antenatal care is also important. Women who live near to a health facility have more antenatal visits and those who have access to a Community Health Worker are more likely to have an early first visit.

Identifying sub-groups of women who do not use maternal health services is important for policy and intervention strategies. Recommendations to improve antenatal care include:

• introducing programmes offering high quality antenatal care but with a reduced number of visits
• establishing whether a pregnancy is wanted and giving individualised care and support to women with unwanted pregnancies
• encouraging high risk women (such as teenagers, unmarried mothers and those with short birth intervals or many children) to use antenatal care services more frequently so that complications or risks can be identified and advice on delivery given
• promoting the use of family planning methods to prevent unplanned and high risk pregnancies
• exposing women to the other range of services available in the modern health sector so that the effect on family health may be amplified.

Source(s):
'Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities' by M. Magadi, N. Madise and R. Rodrigues, Social Science and Medicine 51 (2000)

Funded by: The Population Council; University of Southampton, UK

id21 Research Highlight: 30 March 2001

Further Information:
Monica Magadi
African Population and Health Research Centre
The Population Council (East and Southern Africa Regional Office)
PO Box 17643
Nairobi
Kenya

Tel: +254 2 713480/1-3
Fax: +254 2 713479
Contact the contributor: mmagadi@popcouncil.or.ke

Population Council

Nyovani Madise
Department of Social Statistics
University of Southampton
Southampton
SO17 1BJ
UK

Tel: +44 (0)23 8059 2534
Fax: +44 (0)23 8059 3846
Contact the contributor: njm@socsci.soton.ac.uk

University of Southampton

Other related links:
See this issue of International Health Matters on safer motherhood.

Find details of research and other initiatives on the WHO's safer motherhood site.

Check the Safer Motherhood site for a variety of factsheets and other resources.