High quality prenatal or antenatal care (ANC) is an essential component of the reproductive, maternal, newborn and child health continuum of care. During the critical prenatal period, health care providers can educate women about healthy pregnancy behaviors, danger signs of complications, breastfeeding and family planning; identify and treat pregnancy-related conditions such as pre-eclampsia/eclampsia; refer mothers to specialized care when necessary; encourage the use of a skilled birth attendant; and minimize the risk of mother-to-child transmission of HIV. For many women around the world, an ANC visit is their first adult contact with the health care system, serving as a gateway to health services both during and beyond maternity care. In addition to diagnosing and managing pregnancy-related complications, ANC provides an opportunity to screen for and treat other chronic conditions and non-communicable diseases. The newest guidelines from the World Health Organization recommend that women attend 8 ANC visits.
Globally, 85% of pregnant women attend at least one ANC visit with a skilled health professional, and 58% attend at least 4 ANC visits. However, ANC utilization varies within and among countries: One study found that the percentage of women who attended at least 4 ANC visits ranged from 18% in Guatemala to 81% in Nicaragua. A number of factors including socioeconomic status, place of residence and education level affect a woman’s likelihood of attending ANC, contributing to enormous disparities in access and utilization.
The quality of care during an antenatal visit is also important. Particularly in low-resource settings, shortages in essential medicines, equipment and trained staff are barriers to providing high quality care. In addition, the content of care delivered during pregnancy is poorly measured, limiting the ability to identify and address weaknesses. Integrating ANC with other health services has the potential to improve utilization, quality and outcomes, but additional research is needed. Another approach designed to improve the quality of care is group-based ANC. Researchers in recent years have begun to assess the feasibility and acceptability of group care models such as CenteringPregnancy in diverse global settings, including Malawi and Tanzania.
Maximizing the life-saving potential of ANC requires health systems strengthening, which includes ensuring adequate training, supplies and infrastructure and a focus on quality.
In June 2014, as a part of the Advancing Dialogue on Maternal Health Series, the MHTF hosted a panel discussion at the Woodrow Wilson Center to examine innovative models for delivering high quality antenatal care.