Maternal Health

Antenatal Care

Pregnant women complete a full course of quality antenatal care (ANC)

Complete and quality antenatal care can prevent up to 27% of maternal deaths and increase by 7% the likelihood of a facility delivery.1 USAID: Ending Preventable Maternal Mortality: USAID Maternal Health Vision for Action
USAID
June 2014 
This is a periodic behavior that needs to be practiced at least four times during pregnancy.

Key Points from Global Research

  • Improving a woman’s understanding of the services provided early in pregnancy can allow her to be more actively engaged in her pregnancy, solicit support where required and complete all recommended ANC visits.
  • Leveraging and improving social and partner support to plan for all aspects of pregnancy, including ANC, can encourage women to complete all recommended ANC visits and better adhere to provider recommendations.

Behavior Profile Sample: Antenatal Care

A Behavior Profile is a summary analysis of each behavior. This sample draws from global evidence and illustrates the result of using the Create Behavior Profiles Tool to analyze factors, supporting actors and strategies and to ensure logical pathways exist between strategies proposed and factors related to the practice of the behavior. This sample may be used as a starting point or reference for creating country-specific Behavior Profiles.

Create Behavior Profiles

Improve maternal and child survival
Pregnant women complete a full course of quality antenatal care (ANC)
Percentage of women who had a live birth in the three years preceding the survey who had 4+ antenatal care visits

Behavior Analysis

Strategy

STEPS

What steps are needed to practice this behavior?
  1. Recognize signs and symptoms of pregnancy
  2. Decide to seek ANC early - by the end of the first trimester
  3. Plan transport, resources, and logistics
  4. Attend all recommended ANC visits
  5. Obtain all required services from qualified provider at each visit
  6. Adhere to provider instructions during and following each visit, including when to return for the next visit

Click on any box
        to see the pathwaysA pathway illustrates how elements in the Behavior Profile are linked. When read from right to left, a pathway highlights how strategies are expected to address the factors to enable adoption of the Accelerator Behavior.  
        of the behavior.

FACTORS

What factors may prevent or support practice of this behavior? These should be analyzed for each country context.
Structural
Accessibility: Pregnant women cannot access health facilities because they are too far
Accessibility: Pregnant women do not attend multiple ANC visits because they struggle to afford the costs that come in addition to on-going essential expenditures
Service Provider Competencies: Pregnant women cannot obtain quality ANC because providers neither respect them nor effectively communicate relevant technical information or explain the benefits of the different services, tests, and medications given during ANC
Service Experience: Pregnant women do not go for ANC because the health facilities often lack the tests, medications, or supplements that women need, or payment is required when services and products should be free
Social
Family and Community Support: Many pregnant adolescents and unmarried women are reluctant to seek early care because of stigma or the risk that they will be asked to leave school or quit their job
Family and Community Support: Pregnant women do not plan to attend, or attend ANC because family and community members do not encourage or support their attendance
Norms: Pregnant women do not seek ANC because many societies have strict cultural or traditional practices around disclosure of pregnancy
Internal
Attitudes and Beliefs: Pregnant women do not always perceive a value to multiple ANC visits if they have already had one or more healthy pregnancies
Attitudes and Beliefs: Pregnant women do not always comply with provider's instructions particularly related to medications, supplements, or foods because of beliefs about the adverse effects of the medication or foods on their fetus
Knowledge: Most pregnant women attend at least one ANC visit because they understand its benefits

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Ensure maternity care is accessible via insurance schemes, conditional cash transfers (CCTs) or other financing
Policymakers: Ensure pregnant adolescents can still attend school
Providers: Offer counseling and support to pregnant women during ANC visits, including thorough explanations of services provided as well as the importance of multiple visits and adherence to supplements or medications given
Logistics Personnel: Monitor and properly forecast stock of essential tests, medicines, and supplements
Managers: Provide effective supervision and on-site support to ensure quality ANC services
Community
Community and Religious Leaders: Publicly support or promote ANC including programs that attempt to reduce stigma and encourage women to talk to their partners about early pregnancy care
Community Health Workers/Peer Educators: Encourage or actively support women to seek a full course of ANC and to continue following provider's instructions once at home.
Household
Family Members: Actively participate in ANC and support women, especially first-time mothers and adolescents, in all aspects of pregnancy and delivery planning
Male Partners: Actively support finances, planning, and transportation for ANC for pregnant women

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Financing: Expand free or low-cost access to products and services through vouchers or fee exceptions to ensure access to ANC
Financing: Finance task-shifting and explore community-based service delivery such as iron and folic acid supplements
Policies and Governance: Adopt and enforce policies to permit pregnant adolescents to attend school
Policies and Governance: Establish a policy for areas with poor health facility access to have the most basic ANC services, such as iron and folic acid supplement resupply managed at the community level
Systems, Products and Services
Supply Chain: Strengthen supply chains for essential drugs, supplements, and preventative medicines for ANC
Quality Improvement: Train and support providers to emphasize value of completing all ANC visits as well as active birth planning
Quality Improvement: Expand services and improve structures, including hours offered, types of services available, transparent costing of services when appropriate and use of ANC outreach services to encourage pregnant women to use ANC
Quality Improvement: Ensure that services are client- and family-friendly and that counseling on follow-up care is provided to both the pregnant women and any family members accompanying her
Demand and Use
Communication: Use targeted media, including SMS where possible, to send tailored reminders and tips for pregnant women and their families on both ANC attendance and adherence to supplements like iron and folic acid
Communication: Create pregnancy and new-mother groups to help mothers understand the benefit of care throughout pregnancy and the post-partum period
Collective Engagement: Train and use traditional leaders and traditional birth attendants to encourage women to seek early and multiple ANC visits

Global Status of Accelerator Behavior

Percentage of women who had a live birth in the three years preceding the survey who had 4+ antenatal care visits

Malaria Indicator Survey, The DHS Program Indicator Data API, The Demographic and Health Surveys (DHS) Program

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