Hannah Tappis | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: This study examines the relationship between the timing of the first ANC check-up and the provision of WHO recommended services in Pakistan.

Methods: The study uses data from a representative household survey of Sindh with a sample comprising of 4,000 women aged 15-49. The survey obtained information on the timing of the first ANC check-up, the elements of care provided and a range of socio-economic and demographic characteristics. Bivariate analysis was conducted to examine the relationship between receiving six WHO recommended services during pregnancy – used as a proxy for the quality of care received – and the timing of the first ANC check-up. Multivariate analysis was conducted to identify predictors of the first ANC check-up within three months of pregnancy.

Results: Most women in Sindh receive an ANC check-up. However, there is substantial variation in the timing of the first ANC check-up by household wealth: the median time to the first ANC check-up is 3 months for women in the richest and 7 months for women in the poorest wealth quintiles. In multivariate analysis, after controlling for a range of variables, women in the poorest quintile were much less likely to receive an early ANC check-up. Higher parity and lower levels of education were also associated with a later ANC check-up. A delay in obtaining ANC was associated with fewer elements of recommended care received, i.e. with poorer quality of care.

Conclusions: In Sindh, the timing of the first ANC check-up determines the content of services provided to pregnant women. Poorer women receive lower levels of care during pregnancy because of delayed ANC check-ups. These findings emphasize the need for programs to motivate women to make an early first ANC check-up. Such a focus is most likely to benefit the poorest, least educated and highest parity women.