Health Policy and Planning, Vol 14, 38-48, Copyright © 1999 by Oxford University Press
S Bloom, T Lippeveld and D Wypij
Evidence to support that antenatal screenings and interventions are
effective in reducing maternal mortality has been scanty and studies have
presented contradictory findings. In addition, antenatal care utilization
is poorly characterized in studies. As an exposure under investigation,
antenatal care should be well defined. However, measures typically only
account for the frequency and timing of visits and nor for care content. We
introduce a new measure for antenatal care utilization, comprised of 20
input components covering care content and visit frequency. Weights for
each component reflect its relative importance to better maternal and child
health, and were derived from a survey of international researchers.This
composite measure for antenatal care utilization was studied in a
probability sample of 300 low to middle income women who had given birth
within the last three years in Varanasi, Uttar Pradesh, India. Results
showed that demarcating women's antenatal care status based on a simple
indicator - two or more conducted to examine the effect of antenatal care
utilization on the likelihood of using safe delivery care, a factor known
to decrease maternal mortality. After controlling for relevant
socio-demographic and maternity history factors, women with a relatively
high level of care (at the 75th percentile of the score) had an estimated
odds of using trained assistance at delivery that was almost four times
higher than women with a low level of care (at the 25th percentile of the
score) (OR=3.97, 95% CI=1.96, 8.10). Similar results were obtained for
women delivering in a health facility versus at home. This strong positive
association between level of care obtained during pregnancy and the use of
safe delivery care may help explain why antenatal care could also be
associated with reduced maternal mortality.
ARTICLES
Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India
Carolina Population Center, Chapel Hill, NC, USA; John Snow Inc./Morocco, Rabat, Morocco; Harvard School of Public Health, Boston, MA, USA
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