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Disparities in Antenatal Care Utilization in Mesoamerica and Beyond

By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Antenatal care (ANC) is a crucial component of ensuring optimal health outcomes for mothers and newborns. The World Health Organization (WHO) recommends that women attend at least four ANC visits during pregnancy starting in the first trimester. ANC visits often serve as a gateway to health care for women, particularly in low-resource settings. Unfortunately, many women around the world do not access ANC at health facilities due to a number of barriers, including the inability to afford services and long distance from health facilities. In numerous settings, women with the highest levels of education and from the wealthiest socioeconomic strata are more likely to attend at least four ANC visits.

In a study published in BMC Pregnancy and Childbirth, Dansereau and colleagues surveyed women of low socioeconomic status in five Mesoamerican countries—Guatemala, Honduras, Mexico, Nicaragua, Panama and El Salvador—about their history of receiving ANC during their last pregnancy. In the entire multinational sample, 56% of women reported having attended a skilled ANC visit during the first trimester of their most recent pregnancy. However, that percentage varied widely, from just 18% in Guatemala to 74% in El Salvador. The percentage of women who attended at least four ANC visits per the WHO recommendation ranged from 18% in Guatemala to 81% in Nicaragua. Consistent with previous findings, the researchers identified a number of factors that were significantly associated with a reduced likelihood of skilled ANC attendance in more than one of these countries: low maternal education, adolescent pregnancies, unwanted pregnancies, speaking an indigenous language, high parity, lack of media exposure and being unmarried.

Studies on various populations have found a number of other factors influencing ANC utilization behavior. For example, women in Kenya with unwanted pregnancies are less likely to receive ANC and tended to seek ANC later in pregnancy. Migrant women are also less likely to receive adequate, timely ANC services. In Ethiopia, Vietnam and in many other countries, skilled ANC utilization tends to be lower in rural areas compared to urban or suburban regions.

These studies looking at ANC utilization in different settings can shed light on patterns and distinctions across diverse populations, enabling researchers and public health professionals to identify vulnerable populations and tailor ANC interventions accordingly.

Review the evidence on effective antenatal interventions that can help prevent maternal and newborn mortality and morbidity.

Find additional resources on antenatal care on the MHTF website.

Categories: Maternal Health

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