1. Antenatal care MDG 5, Target 5b, Indicator 5.5
Workshop on MDG monitoring to 2015 and beyond
Bangkok 9-13 July 2012
Liliana Carvajal
UNICEF

2. 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

3. Antenatal care Background, definitions, relevance Regional perspective
Measuring the standard indicator
Measurement challenges

4. Antenatal care Background, definitions, relevance Regional perspective
Measuring the standard indicator
Measurement challenges

5. 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.

6. 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.
The antenatal period is also an ideal opportunity to supply information on future birth spacing, which is recognized as an important factor in improving infant survival.

7. 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.
Basic antenatal care provides women with a package of preventive interventions, including nutritional advice.
Women are also alerted to danger signs that may threaten their pregnancy and given support in planning a safe delivery.

8. 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.

9. Antenatal care Background, definitions, relevance Regional perspective
Measuring the standard indicator
Measurement challenges

10. Antenatal care – at least one visit Proportion 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 in developing regions : 64 % in 1990 to 81% in 2009
Southern Asia and SSA are the regions with lowest coverage
Source: MDG report 2011

11. ANC4 – at least four visits with any provider Proportion 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.
A minimum of four antenatal care visits is recommended to ensure that pregnant women receive the interventions they need to prevent and manage complications.
Source: MDG report 2011

12. Antenatal care Background, definitions, relevance Regional perspective
Measuring the standard indicator
Measurement challenges

13. Standard Indicators – ANC1
Antenatal care coverage (at least one visit)
Proportion of women age 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
Services =
Blood pressure
Urine sample
Blood sample
IPTp (if relevant)

14. Standard Indicators – ANC4
Antenatal care coverage (at least four visits)
Proportion of women age 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

15. 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.

16. Eligibility Women of reproductive age (15-49 years)
Live birth in the two or five years preceding interview

17. 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

18. Reporting of ANC1 - Surveys
Cambodia example – skilled providers doctor, nurse and midwife

19. 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

20. Household survey – women’s questionnaire
ANC4 indicator
For this indicator the provider is not included
Additional questions on quality of care
Services =
Blood pressure
Urine sample
Blood sample
IPTp (if relevant)

21. Reporting of ANC4-Surveys

22. Antenatal care Background, definitions, relevance Regional perspective
Measuring the standard indicator
Methodological challenges

23. 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
Maintain the broad categories shown in the model Q.
Doctors, nurses midwives and auxiliary midwives are skilled health personnel who have midwifery skills to manage normal deliveries and diagnose or refer obstetric complications.
For ANC1 the specific provider needs to be specified – needs to be adapted properly within countries to ensure that the categories that are included –usually MOH capture the main service providers and are recognized by respondents

24. Prepared by: Liliana Carvajal Statistics and Monitoring Section UNICEF/New York