Initiation of Antenatal Care, Content of Care Received and Determinants for Early Visit -An Opportunity Still Missed in Pakistan

Abstract

BACKGROUND: Antenatal care coverage increased tremendously in the last two decades in developing countries, with at least half of women having 4 or more visits to a clinic. But this rise in utilization did not translate into substantially lower maternal and neonatal mortality rates. OBJECTIVE: To determine the time of initiating antenatal care and assess the effect of time of initiation of antenatal care (ANC) on the content of care received and factors associated with the time of initiating care. METHODS: This was a retrospective cross-sectional study conducted from September 2020 to December 2020. The study population included all women who delivered at the hospital. The time of the first antenatal visit and content of care received by the woman was assessed. The primary outcome variable was the time of the first antenatal visit. Secondary measures included the content of care received by women. RESULTS: Of the 1388 women included, only 160 (11.5%) had their first visit before 14 weeks of pregnancy. When stratified according to time of visit, blood pressure measurement (p=0.021), weight measurement (p= 0.011), urine testing (p=0.015) and iron and folic acid supplementation (p=0.013) were significantly greater for women who started care within three months. Women who were older (p˂0.001) and had delivered before (p=0.001) were more likely to access antenatal care earlier. Similarly, women with some education (p ˂0.001) and higher monthly income (p=0.003) started visits sooner than those who were uneducated and had lesser income. On the multivariable model, lower age, being nulliparous, no formal education and lower income were determinants of late booking. CONCLUSION: The prevalence of early initiation of antenatal care was very low. The content of care received by women who presented early was also significantly different from those who presented late. Older age, previous birth; education and monthly income were determinants of early antenatal care visits. Awareness programs for early initiation of antenatal care need to be implemented.