Article Text

Download PDFPDF

Not just a number: examining coverage and content of antenatal care in low-income and middle-income countries
  1. Lenka Benova1,
  2. Özge Tunçalp2,
  3. Allisyn C Moran3,
  4. Oona Maeve Renee Campbell1
  1. 1 Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
  2. 2 Department of Reproductive Health and Research, WHO, Geneva, Switzerland
  3. 3 Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland
  1. Correspondence to Dr Lenka Benova; lenka.benova{at}


Introduction Antenatal care (ANC) provides a critical opportunity for women and babies to benefit from good-quality maternal care. Using 10 countries as an illustrative analysis, we described ANC coverage (number of visits and timing of first visit) and operationalised indicators for content of care as available in population surveys, and examined how these two approaches are related.

Methods We used the most recent Demographic and Health Survey to analyse ANC related to women’s most recent live birth up to 3 years preceding the survey. Content of care was assessed using six components routinely measured across all countries, and a further one to eight additional country-specific components. We estimated the percentage of women in need of ANC, and using ANC, who received each component, the six routine components and all components.

Results In all 10 countries, the majority of women in need of ANC reported 1+ ANC visits and over two-fifths reported 4+ visits. Receipt of the six routine components varied widely; blood pressure measurement was the most commonly reported component, and urine test and information on complications the least. Among the subset of women starting ANC in the first trimester and receiving 4+ visits, the percentage receiving all six routinely measured ANC components was low, ranging from 10% (Jordan) to around 50% in Nigeria, Nepal, Colombia and Haiti.

Conclusion Our findings suggest that even among women with patterns of care that complied with global recommendations, the content of care was poor. Efficient and effective action to improve care quality relies on development of suitable content of care indicators.

  • maternal health
  • cross-sectional survey
  • health services research

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Sanni Yaya

  • Contributors OMRC had the original idea for this analysis. OMRC, LB and ÖT designed the analyses. LB conducted the data analysis and drafted tables and figures. OMRC, LB, ACM and ÖT participated in interpreting the results, and in drafting and commenting on the paper.

  • Funding The research in this manuscript was supported by funding from MSD through its MSD for Mothers programme. Funding was used for general financial support, including staff salaries, travel and overheads.

  • Disclaimer The content of this report is solely the responsibility of the authors and does not represent the official views of MSD. MSD for Mothers is an initiative of Merck & Co, Inc, Kenilworth, New Jersey, USA. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the institutions to which the authors are affiliated.

  • Competing interests LB reports receiving a research grant from Merck Sharp and Dohme (MSD) through its MSD for Mothers programme.

  • Patient consent Not required.

  • Ethics approval Research Ethics Committee of the London School of Hygiene and Tropical Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data used in this article are available to download for research purposes upon registration;