Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, South Korea.
Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, South Korea.
J Glob Health. 2024 Oct 18;14:04188. doi: 10.7189/jogh.14.04188.
Antenatal care (ANC) quality is important to maternal and neonatal mortality. However, trends in the quality of ANC received by pregnant women in India have been understudied. This paper seeks to fill this gap by examining the long-term patterns nationwide and the state-specific prevalence of inadequate ANC quality received by pregnant women in India.
We utilised data from four National Family Health Surveys (NFHS) conducted in 1999 (NFHS-2), 2006 (NFHS-3), 2016 (NFHS-4), and 2021 (NFHS-5) across India's 36 states/union territories (UTs). The sample includes mothers who had given birth within three years (NFHS-2) and five years (NFHS-3, NHFS-4, and NFHS-5) before each survey. We define inadequate ANC quality as not completing seven essential ANC services (weight measurement, blood pressure measurement, urine sampling, blood sampling, provision of iron supplements, provision of tetanus vaccination, and ultrasound scans) during pregnancy. We calculated the standardised absolute change to quantify the change in the share of women receiving inadequate quality ANC nationally and by each state/UT. Additionally, we estimated the population headcount of mothers who received inadequate-quality ANC in 2021 and identified the socioeconomic correlates associated with inadequate ANC quality.
The prevalence of inadequate ANC quality substantially declined between 1999-2021, from 84.8% (95% confidence interval (CI) = 84.1-85.5) to 28.8% (95% CI = 28.5-29.2). However, between-state inequality in ANC quality has increased over this time. We identified a weak correlation between prevalence and population headcounts in 2021. Socioeconomically disadvantaged groups exhibited a higher prevalence of inadequate quality of ANC than less disadvantaged groups.
The proportion of pregnant women receiving inadequate ANC quality has decreased over time throughout India. However, multi-faceted efforts at national and state levels are necessary to enhance the effectiveness of existing policies. Additionally, innovative and targeted approaches are required to ensure the timely and equitable provision of high-quality ANC.
产前护理（ANC）质量对母婴死亡率至关重要。然而，印度孕妇接受的 ANC 质量趋势一直研究不足。本文通过研究全国范围内的长期模式和印度孕妇接受的 ANC 质量不足的州特定流行率，旨在填补这一空白。
我们利用了在印度 36 个邦/联邦属地（UT）进行的四次全国家庭健康调查（NFHS）的数据：1999 年（NFHS-2）、2006 年（NFHS-3）、2016 年（NFHS-4）和 2021 年（NFHS-5）。样本包括在每次调查前三年内（NFHS-2）和五年内（NFHS-3、NFHS-4 和 NFHS-5）分娩的母亲。我们将 ANC 质量不足定义为在怀孕期间未完成七项基本 ANC 服务（体重测量、血压测量、尿液取样、血液取样、提供铁补充剂、提供破伤风疫苗接种和超声扫描）。我们计算了标准化绝对变化，以量化全国和每个邦/UT 接受 ANC 质量不足的妇女比例的变化。此外，我们估计了 2021 年接受 ANC 质量不足的母亲的人口数量，并确定了与 ANC 质量不足相关的社会经济因素。
1999-2021 年间，ANC 质量不足的比例大幅下降，从 84.8%（95%置信区间[CI] 84.1-85.5）降至 28.8%（95% CI 28.5-29.2）。然而，在此期间，邦/UT 之间 ANC 质量的不平等程度有所增加。我们发现 2021 年的患病率与人口数量之间存在弱相关性。社会经济地位较低的群体比社会经济地位较高的群体更有可能接受 ANC 质量不足。
随着时间的推移，印度各地接受 ANC 质量不足的孕妇比例有所下降。然而，需要在国家和邦层面做出多方面的努力，以提高现有政策的有效性。此外，还需要采取创新和有针对性的方法，以确保及时和公平地提供高质量的 ANC。
