Antenatal care MDG 5, Target 5b, Indicator 5.5

1. Antenatal careMDG 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.

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.

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 visitProportion 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 1990 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 providerProportion 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. 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 15-49 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

14. Standard Indicators – ANC4 Antenatal care coverage (at least four visits) Proportion of women age 15-49 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

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

24. Prepared by: Liliana Carvajal Statistics and Monitoring Section UNICEF/New York lcarvajal@unicef.org www.childinfo.org