Maternal Health

Current Status + Progress

Updated: Jul 2015

Only half of women worldwide receive the recommended amount of care during pregnancy

Regular contact with a doctor, nurse or midwife during pregnancy allows women to receive services vital to their health and that of their future children. The World Health Organization (WHO) recommends a minimum of four antenatal care visits. However, global estimates indicate that only about half of all pregnant women receive this recommended amount of care.

Antenatal care can help women prepare for delivery and understand warning signs during pregnancy and childbirth. It can be a source for micronutrient supplementation, treatment of hypertension to prevent eclampsia, immunization against tetanus, HIV testing and medications to prevent mother-to-child transmission of HIV in cases of HIV-positive pregnant women. In areas where malaria is endemic, health personnel can also provide pregnant women with medications and insecticide-treated mosquito nets to help prevent this debilitating, sometimes deadly disease.

COVERAGE OF ANTENATAL CARE

Globally, while 82 percent of pregnant women access antenatal care at least once with a skilled health personnel, only half (54 per cent) receive at least four antenatal visits – the recommended minimum. In regions with the highest rates of maternal mortality, such as sub-Saharan Africa and South Asia, even fewer women received at least four antenatal visits (47 per cent and 38 per cent, respectively).

Regional coverage of at least one antenatal care visit with a skilled health personnel ranges from 71 per cent in South Asia to over 90 per cent in East Asia and the Pacific and Latin America and the Caribbean, although disparities are common within and among countries. In viewing the data, it is important to remember that these percentages bear no reflection on either the skill level of the health-care provider or the quality of care, both of which can influence whether such care actually succeeds in bringing about improved maternal and newborn health.

Most pregnant women access skilled antenatal care at least once, but only about half receive the recommended minimum of four antenatal care visits

Percentage of women aged 15–49 attended at least once during pregnancy by skilled health personnel (ANC1) and percentage attended by any provider at least four times (ANC4), by region, LDCs and world, 2010–2014

Note: Estimates are based on a subset of countries with available data for the period 2010–2014. The ANC1 analysis includes 98 countries covering 94% of births worldwide, and the ANC4 analysis includes 92 countries covering 66% of births worldwide. Estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS.

Most pregnant women access skilled antenatal care at least once, but only about half receive the recommended minimum of four antenatal care visits

DISPARITIES IN COVERAGE

Although overall levels of antenatal care are relatively high across regions, disparities are revealed when coverage is examined in light of household wealth and urban or rural residence. In South Asia and sub-Saharan Africa the urban-rural gap in coverage (four or more visits with any provider) exceeds 20 percentage points in favor of urban areas. This gap has not closed within the last decade.

Urban women are far more likely than their rural counterparts to receive antenatal care

Percentage of women attended 4 or more times by any provider during pregnancy, by residential settings, 2009-2013

* Excludes China.

Source: UNICEF global databases 2015 based on from MICS, DHS and other nationally representative sources.

Note: Estimates for the year 2000 refer to an average of the period 1999-2007, estimates for the year 2014 refer to an average of the period 2000- 2014. LDC estimates are based on a subset of 22 countries, covering 68% and 73% of births in urban and rural areas respectively in 2014. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate a global average as well as regional average for CEE/CIS, Latin America and the Caribbean and Middle East and North Africa

Urban women are far more likely than their rural counterparts to receive antenatal care

Percentage of women attended 4 or more times by any provider during pregnancy, by residential settings, 2009-2013

* Excludes China.

Source: UNICEF global databases 2015 based on from MICS, DHS and other nationally representative sources.

Globally, women in the richest 20 per cent of the population are also more likely to receive antenatal care than poorer women, especially in the most deprived regions. In South Asia, for instance, women in the richest quintile are almost twice as likely as women in the poorest quintile to have at least one antenatal care visit with a skilled provider (94 per cent versus 50 per cent). Large disparities in coverage based on wealth are also found in sub-Saharan Africa, particularly in West and Central Africa.

Women in the richest quintile are over 50 per cent more likely to receive antenatal care than those in the poorest quintile

Percentage of women attended at least once during pregnancy by skilled health personnel, by region and by wealth quintiles, 2009─2013

* Excludes China.

Notes: Global estimates are based on a subset of 84 countries, covering 60 per cent of births worldwide (excluding China, for which data are unavailable). Regional estimates represent data from countries covering at least 50 per cent of regional births. Data coverage was insufficient to calculate the regional averages for CEE/CIS, Latin America and the Caribbean and the Middle East and North Africa.

Source: UNICEF global databases, 2014, based on MICS, DHS and other nationally representative sources.

Women in the richest quintile are over 50 per cent more likely to receive antenatal care than those in the poorest quintile

Percentage of women attended at least once during pregnancy by skilled health personnel, by region and by wealth quintiles, 2009─2013

* Excludes China.

Source: UNICEF global databases, 2014, based on MICS, DHS and other nationally representative sources.

REFERENCES

UNICEF, Progress for Children Beyond Averages: Learning from the MDGs, New York, 2015

UNICEF, Progress for Children: A report card on maternal mortality, Report No. 7, UNICEF, New York, 2008.

UNICEF, The State of the World’s Children 2014, UNICEF, New York, 2014.

UNICEF/WHO, Antenatal Care in Developing Countries: Promises, achievements and missed opportunities, WHO, Geneva, 2003.

WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 1990 to 2013, WHO, Geneva, 2014.

See more at: http://data.unicef.org/maternal-health/antenatal-care#sthash.W01W4q5P.dpuf

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Antenatal Care Coverage

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Publication

Trends in Maternal Mortality: 1990 to 2013

Maternal Health

Jan 01, 2013

This report presents new estimates of maternal mortality produced by the Maternal Mortality Estimation Inter-Agency Group (MMEIG) as part of global and country monitoring of the Millennium Development Goal five. The estimates are the seventh in a series of analyses carried out by MMEIG. The report describes estimates of levels and trends in maternal mortality ratio between 1990 and 2013, associated number of maternal deaths and lifetime risk of maternal deaths.

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Notes on the Data

UNICEF – in collaboration with the World Health Organization (WHO) – is the UN organization responsible for monitoring and reporting on indicators in antenatal care coverage: at least one visit with a skilled health provider and at least four visits with any provider. Both are official indicators for MDG 5: Improve maternal health.

MDG indicator

Millennium Development Goal

Target

5.5 Antenatal care coverage (at least one visit with a skilled provider)

Antenatal care coverage (at least four visits with any provider)

Goal 5. Improve maternal health

Target 5.B: Achieve, by 2015, universal access to reproductive health

DEFINITION OF INDICATORS

Antenatal care coverage (at least one visit) is the percentage of women aged 15 to 49 with a live birth in a given time period that received antenatal care provided by skilled health personnel (doctor, nurse or midwife) at least once during pregnancy.

Skilled health personnel refers to workers/attendants that are accredited health professionals – such as a midwife, doctor or nurse – who have been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns. Both trained and untrained traditional birth attendants are excluded.

Antenatal care coverage (at least four visits) is the percentage of women aged 15 to 49 with a live birth in a given time period that received antenatal care four or more times. Available survey data on this indicator usually do not specify the type of the provider; therefore, in general, receipt of care by any provider is measured.

Antenatal visits present opportunities for reaching pregnant women with interventions that may be vital to their health and well-being and that of their infants. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content of antenatal care visits, which should include:

· blood pressure measurement

· urine testing for bacteriuria and proteinuria

· blood testing to detect syphilis and severe anaemia

· weight/height measurement (optional).

Measurement limitations. Receiving antenatal care during pregnancy does not guarantee the receipt of interventions that are effective in improving maternal health. Receiving antenatal care at least four times, which is recommended by WHO, increases the likelihood of receiving effective maternal health interventions during antenatal visits. Importantly, although the indicator for ‘at least one visit’ refers to visits with skilled health providers (doctor, nurse or midwife), ‘four or more visits’ refers to visits with any provider, since standardized global national-level household survey programmes do not collect provider data for each visit. In addition, standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries.