Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: High levels of antenatal care (ANC) coverage are necessary but not sufficient to reduce maternal and neonatal morbidity and mortality. It is also crucial that services be of high quality. Continuity of care is a cornerstone of quality care. We propose a novel approach to measuring continuity of care using existing data and identify correlates of receipt continuity of ANC in Mexico.
Methods: We used the 2012 National Health and Nutrition Survey (ENSANUT; population N= 9,052,044). Our sample includes women who reported a live birth between 2006 and 2012 and answered a series of questions about ANC preceding that birth. We classified ANC as continuous, and thus adequate, if it began during the first trimester of pregnancy, if ≥4 ANC visits and at least 7 out of 8 evidence-based procedures were received during ANC visits during the last pregnancy. In order to identify factors associated with receipt of adequate ANC, we used multivariable logistic regression and included individual, household, and locality-level covariates. We also estimated marginal effects for ease of interpretation.
Results: 98.5% of women received some exposure to ANC during their last pregnancy. Only 71.5% (CI95%: 69.7; 73.2) of women received adequate ANC. The probability of receiving adequate ANC is greater among women with more schooling; having medical insurance, and high socio-economic level. The probability is reduced among indigenous. Important differences in the coverage of adequate ANC among subnational health systems were identified: below the national average they were Chiapas: 48.7%, Puebla: 58.2% and Oaxaca: 62.4%. Whereas Guanajuato (82.3%), Chihuahua (80.4%) and Zacatecas (80.2%) were over the national average.
Conclusions: ANC coverage is high if only a single indicator is considered; however, when we consider the concept of continuity of care, coverage is much lower. Improving quality of ANC includes improving continuity of care for women before, during, and after pregnancy.