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| Special emphasis must be placed on prenatal and post-natal care, essential obstetric care and care for newborns, particularly for those living in areas without access to services. | Target: Achieve, by 2015, universal access to reproductive health |
The challenge
The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants.
Regular contact with a doctor, nurse or midwife allows health personnel to manage the pregnancy and provide a variety of services, which can include treatment of hypertension to prevent eclampsia, tetanus immunization, intermittent preventive treatment for malaria and distribution of insecticide-treated nets, prevention of mother-to-child transmission of HIV, micronutrient supplementation, and birth preparedness, including information about danger signs during pregnancy and childbirth. The antenatal period also provides an opportunity to supply information on birth spacing, which is recognized as an important factor in improving infant survival.
The World Health Organization (WHO) recommends a minimum of four antenatal visits. According to WHO guidelines, antenatal care visits should include, at a minimum, the measurement of blood pressure, testing of urine for bacteriuria and proteinuria, and blood tests to detect syphilis and severe anemia.
High levels of antenatal care coverage across the developing world
According to the latest estimates, 75 per cent of women in the developing world receive antenatal care from a skilled health provider at least once during pregnancy. Around 9 in 10 pregnant women are attended at least once in Latin America/Caribbean, Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS) and East Asia/Pacific. In the Middle East/North Africa, 72 per cent of women receive antenatal care from a trained provider, followed by sub- Saharan Africa (69 per cent) and South Asia (65 per cent). The countries with the lowest levels of coverage of at least one antenatal care visit during pregnancy are Afghanistan (16 per cent), Somalia (26 per cent), the Lao People’s Democratic Republic (27 per cent) and Ethiopia (28 per cent).
Three quarters of women in the developing world receive some antenatal care: Percentage of women aged 15–49 receiving antenatal care at least once during pregnancy, by region (2000–2006)
Source: UNICEF, Progress for Children: A Report Card on Maternal Mortality, 2008
Globally, less than half of all pregnant women benefit from the minimum recommended four antenatal visits. For example, in a subset of sub-Saharan African countries with available data, 69 per cent of pregnant women received antenatal care at least once in 2000–2006, compared with 42 per cent who received it at least four times.
Less than half of women in sub-Saharan Africa and South Asia benefit from the recommended four antenatal visits: Percentage of women aged 15–49 receiving antenatal care at least once during pregnancy and the percentage receiving antenatal care at least four times (2000–2006)
Source: UNICEF, Progress for Children: A Report Card on Maternal Mortality, 2008
These antenatal care data do not reflect the quality of care, which is difficult to measure. Yet, it is essential to ensure the quality of antenatal care so that services provided contribute to improved maternal health.
Regions have extended coverage of antenatal care since mid-1990s
Every region made major progress over the past decade in extending coverage of antenatal care for women at least once during pregnancy. Across the developing world (excluding China), the proportion of women receiving antenatal care at least one time increased from 60 per cent in 1995 to 75 per cent in 2005, based on the subset of countries with trend data. Although it currently has the lowest coverage, South Asia has made the fastest recent progress, improving its coverage from 46 per cent in 1995 to 65 per cent in 2005. Similarly, the Middle East and North Africa also experienced significant improvements during this time period, with coverage rising from 56 per cent to 71 per cent.
Coverage of antenatal care increased in all developing regions during the past decade: Trends in the percentage of women aged 15–49 receiving antenatal care at least once during pregnancy, by region, based on a subset of 67 countries with trend data (around 1995 and around 2005)
Source: UNICEF, Progress for Children: A Report Card on Maternal Mortality, 2008
References
UNICEF. Progress for Children: A Report Card on Maternal Mortality. 2008.
UNICEF/World Health Organization. Antenatal Care in Developing Countries: Promises, Achievements and Missed Opportunities, 2003.