ANTENATAL CAREMDG 5, TARGET 5B, INDICATOR

5.5

Workshop on MDG monitoring to 2015 and beyond

Bangkok 9-13 July 2012Liliana CarvajalUNICEF

MDG 5 – Improve maternal health

Target 5.b – Achieve by 2015, universal access to reproductive health

Indicator 5.5 – Antenatal care coverage

At least 1 antenatal care visit At least 4 antenatal care visits

Background, definitions, relevance Regional perspective Measuring the standard indicator Measurement challenges

Antenatal care

Background, definitions, relevance Regional perspective Measuring the standard indicator Measurement challenges

Antenatal care

What is antenatal care ANC

For pregnant women, regular contact with skilled health personnel (doctor, nurse or midwife) allows for a better management of their pregnancy including a variety of services, such as: treatment of hypertension to prevent eclampsia; tetanus immunization; micronutrient supplementation; and birth preparedness, including information about

danger signs during pregnancy and childbirth.

Why is antenatal care important? Health care during pregnancy is vitally

important in detecting and managing conditions that may complicate pregnancy and childbirth.

The antenatal period presents important opportunities for reaching pregnant women with a number of interventions that may be vital to their health and well-being and that of their infants.

Why is antenatal care important?

Moreover, in countries where malaria is endemic, ANC visits provide pregnant women with intermittent preventive treatment for malaria as well as insecticide-treated mosquito nets;

Women who are HIV-positive receive help in avoiding transmission of the virus to their babies.

ANC4

The World Health Organization (WHO) recommends a minimum of four antenatal visits.

WHO guidelines recommend that antenatal care includes, at a minimum: the measurement of blood pressure, testing of urine for bacteriuria and proteinuria,

and blood tests to detect syphilis and severe

anaemia.

Background, definitions, relevance Regional perspective Measuring the standard indicator Measurement challenges

Antenatal care

Antenatal care – at least one visitProportion of women (15-49 years old) attended at least once by skilled health personnel during pregnancy, 1990 and 2009 (Percentage)

Across all regions, more pregnant women are offered at least minimal care

Since 1990, the proportion of women receiving antenatal care has increased substantially in all regions.

Important progress since 1990 in developing regions : 64 % in 1990 to 81% in 2009

Southern Asia and SSA are the regions with lowest coverage

Source: MDG report 2011

ANC4 – at least four visits with any providerProportion of women (15-49 years old) attended four or more times by any provider during pregnancy, 1990 and 2009 (Percentage)

Not enough women receive the recommended frequency of care during pregnancy.

The proportion of women receiving the recommended number of visits in developing regions remains low, though progress is being made, increasing from 35 per cent in 1990 to 51 per cent in 2009.

Source: MDG report 2011

Background, definitions, relevance Regional perspective Measuring the standard indicator Measurement challenges

Antenatal care

Standard Indicators – ANC1

Antenatal care coverage (at least one visit)Proportion of women age 15-49 years that were

attended at least once by skilled health personnel during pregnancy in the last 2 years

Note:Skilled health personnel comprises: Doctor Nurse Midwife/auxiliary midwife

Standard Indicators – ANC4

Antenatal care coverage (at least four visits)

Proportion of women age 15-49 years that were attended at least four or more times by any provider during pregnancy in the last 2 years

Note:

This indicator refers to 4 or more checks from any provider

Sources

The antenatal care coverage is typically calculated from data collected through national household surveys including: Multiple Indicator Cluster Surveys (MICS) Demographic Health Surveys (DHS), Reproductive Health Surveys and sometimes from data collected from

administrative registrations.

Eligibility

Women of reproductive age (15-49 years)

Live birth in the two or five years preceding interview

Household survey – women’s questionnaire

Includes about 20 questions related to the antenatal period – but the standard ANC1 indicator is based on 2 questions:

Health providers

Reporting of ANC1 - Surveys Cambodia example – skilled providers

doctor, nurse and midwife

Reporting of ANC1 - Surveys Bhutan example – skilled providers:

doctor, nurse/ midwife, health assistant/basic health worker HA/BHW, Associate clinical officer ACO

For global reporting, additional confirmation is needed for other categories

Household survey – women’s questionnaire

ANC4 indicator

For this indicator the provider is not included

Additional questions on quality of care

Reporting of ANC4-Surveys

Background, definitions, relevance Regional perspective Measuring the standard indicator Methodological challenges

Antenatal care

Summary of methodological challenges Type of provider for antenatal care

Questionnaires - coding categories need to be adapted in country MDG indicators – maintain broad coding

categories for comparability Direct communication with country office

to ensure correct interpretation for global reporting

Prepared by:

Liliana Carvajal

Statistics and Monitoring Section

UNICEF/New York

lcarvajal@unicef.org

www.childinfo.org