Maternal Health

Antenatal Care

Pregnant women attend a complete course of 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 Country-specific Behavior Profiles

Improve maternal and child survival
Pregnant women attend a complete course of 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. Begin ANC early, by the end of the first trimester
  2. Plan transport, resources and logistics required to attend ANC
  3. Adhere to provider instructions at 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: Households are far from facilities
Accessibility: Many women struggle to afford the cost inherent in multiple ANC visits and they do not see the value of their investment
Provider Competencies: Many providers do not counsel mothers nor explain the benefits of the different services, tests and medication or supplements given during ANC
Social
Norms: Many societies have strict cultural or traditional practices around disclosure of pregnancy, discouraging early ANC
Family and Community Support: Pregnant adolescents are often reluctant to seek early care because of stigma and risk that they might be asked to leave school
Family and Community Support: Often pregnant women are not encouraged or supported to complete all ANC visits
Internal
Attitudes and Beliefs : Women do not always perceive a value to multiple ANC visits, especially if they have already had one or more healthy pregnancies
Knowledge: Most women say that ANC is important and most attend at least one visit

SUPPORTING ACTORS AND ACTIONS

Who must support the practice of this behavior?
Institutional
Policymakers: Ensure maternity care is accessible to most vulnerable via insurance schemes, conditional cash transfers (CCTs) or other financing
Policymakers: Ensure teenage mothers can still attend school
Providers: Offer counseling and support to pregnant women during ANC including thorough explanations of services provided, importance of multiple visits and adherence to supplements or medication given
Household
Family Members: Actively participate in ANC and support woman, especially first-time mothers and adolescents, in all aspects of pregnancy and delivery planning

POSSIBLE PROGRAM STRATEGIES

How might we focus our efforts based on this analysis?
Enabling Environment
Financing: Finance task-shifting and explore community-based service delivery such as iron folate supplements
Policies and Governance: Encourage policies that permit pregnant teenagers to attend school
Systems, Products and Services
Quality Improvement: Train and support providers to emphasize the value of completing all ANC visits as well as active birth planning
Demand and Use
Communication and Mobilization: Use targeted media, including SMS where possible, to tailor reminders and tips for pregnant women and their families on both ANC attendance and adherence to supplements like IFA
Communication and Mobilization: Create pregnancy and new-mother groups to help mothers understand the benefit of care throughout pregnancy and the post-partum period
Communication and Mobilization: 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

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

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