What you need to know about antenatal care

This is the care you get from health professionals dur­ing your pregnancy. It’s sometimes called pregnancy care or maternity care. You will be offered appointments with a midwife or at times a doctor spe­cialized in pregnancy and birth (obstetrician). This care is started as soon as one gets pregnant and checks for the health of mother and baby. It provides a mother with useful information to help them have a health pregnancy, including advice about healthy eating and exercise.

 Through this form of preven­tive health care, women can learn about healthy behaviors during pregnancy, understand warn­ing signs during pregnancy and childbirth and receive social, emotional and psychological sup­port at this critical time in their lives. Pregnant women can also access micronutrient supplemen­tation, treatment for hyperten­sion to prevent eclampsia as well as immunization against tetanus. Antenatal care can also provide HIV testing and medications to prevent mother-to-child trans­mission of HIV.

 Antenatal care allows women to receive services vital to their health and that of their future children. World Health Organi­zation has updated its recom­mendations from a minimum of four antenatal care contacts to a minimum of eight contacts to reduce perinatal mortality and to improve women’s experience of care. However, data reporting at the global, regional and country levels are currently only avail­able for a minimum of four visits, aligned with the previous recom­mendation.

 These data indicates that the proportion of women receiving at least four antenatal care visits varies greatly between countries ranging from 24% in countries in sub-Saharan Africa to over 90 percent in countries across re­gions of Europe. This disparity greatly affects the outcome of pregnancies and greatly contrib­utes to the number of maternal mortality rate. For instance, glob­ally, while 88 percent of pregnant women access antenatal cares with a skilled health personnel at least once, one in three (69%) re­ceive at least four antenatal care visits. In regions with the high­est rates of maternal mortality, such as central Africa, even fewer women received at least four an­tenatal care visits.

 Evidence indicates that ante­natal care has both indirect and direct effects on maternal and perinatal morbidity and mortal­ity reduction. In Uganda, the ANC attendance rate stands at 97.3% for one visit but 59.9%for four or more visits. Of the 1.5 million babies born in Uganda annually, 38000 are stillbirths. More than half the stillbirths in sub Saha­ran Africa are ante partum (oc­curring during pregnancy before the onset of labor) with the major underlying causes being hyper­tensive disorders, infections and placental complications result­ing in ante partum hemorrhage. Together, these three conditions account for three quarters of ante partum stillbirths in sub Sa­haran Africa for which the cause is known and can be reduced through ANC attendance.

 In Uganda especially, hyper­tensive disorders, anemia, and syphilis are some of leading ma­ternal conditions associated with stillbirths. Evidence indicates that antenatal care has both in­direct and direct effects on ma­ternal and perinatal morbidity and mortality rate reduction. Higher national coverage of ANC is strongly associated with lower ante partum deaths. ANC from a skilled provider is a proven in­tervention aimed at monitoring pregnancy to reduce morbidity and mortality risks for the mother and child that may occur during pregnancy, deliver and postnatal period. This is attributed to the opportunity that the ANC plat­form provides to detect and treat pregnancy related complications and to ensure early identification and mitigation of risk factors for complications during labor and delivery.

 In Uganda, the ANC attendance rates stands at 97.3% for 1 visit but drops to 59.9% for at least four or more visits, rural regions in Uganda have rates as low as 58% for four visits, indicating non completion of up to 45% among pregnant women in rural areas with the worst performing re­gion in the country having a rate of only 44.5%. ANC service provi­sion is part of cluster 2 of the ma­ternal and child health cluster in the Uganda minimum health care package for pregnant women in Uganda. While the country is currently implementing a mini­mum of four ANC visits, the government has incorporated an eight- contact model into the national sexual and reproduc­tive health policy guideline and in 2018 started initiating activi­ties to support a gradual switch to the eight- contact ANC model recently recommended by WHO for low and middle income coun­tries.

 The eight – contact model emphasizes completion of the first visit as early as possible in the first trimester of pregnancy with the next visit scheduled at 20 weeks and then repeat visits at 26, 30 34 and every two weeks until delivery. Given the immi­nent shift to the eight – contact ANC models of service delivery levels in Uganda, combined with a prevailing lack of universal cov­erage for completion of four ANC visits, there is need for research and support from stakeholders to disseminate the information out­lining the benefits and effects of missing ANC attendance to gen­eral population.

 Despite the government efforts to increase the access and use of essential maternal care services such as antenatal care services, the number of women utilizing these ANC services has not in­creased most especially in the rural area. Bivariate analytical studies revealed that the num­ber of ANC visits a woman leav­ing in Karamoja made was highly influenced by education level of women except their age, dis­tance to the health facility, mari­tal status, partner involvement, knowledge of HIV risk reduction towards baby and antenatal care education. More empowerment to pregnant women and their husbands has to be done if ANC attendance and utilization plus mortality rates are to be cabled down.

 Adequate utilization of ante­natal care services is imperative in identifying and reducing risks related to pregnancy. Adequate utilization involves a woman uti­lizing antenatal care services at least four times during pregnancy based on the WHO focused ANC framework. Following the adop­tion of the sustainable develop­ment goals (SDGs), the WHO has equally modified its recom­mendation that a woman must visit ANC services at least four to eight times which is aimed at saving the lives of the mother and unborn baby as well as achieving the global agenda 3.1 goal of re­ducing maternal mortality to 70 deaths per 100000 live births by 2030.

Besides adequate and early utilization of antenatal care ser­vices, accords women with an opportunity for early screening for complications and referrals. It also aids in developing rapport between the woman and the ser­vice provider.

 Studies have shown that effec­tive utilization of antenatal care services helps reduce maternal and neonatal mortality by 20%. In sub–Saharan Africa, Uganda in­clusive, studies have shown that adequate utilization of antenatal care services is low (6.8%) and majority of these countries still don’t conform to the new WHO guideline. Similarly, studies have shown that Uganda is among the countries experiencing chal­lenges in providing quality ante­natal care services.

Besides the recent UDHS, 2016 results showed that over half (60%) of the women visited antenatal care services at least four times compared to 97% of the women who received at least one antenatal care from skilled health personnel. This has kept maternal morbidity and mortal­ity very high over time. Though globally, maternal mortality has receded by 38%, it remained high in developing countries.

 In 2020, an estimated 287,000 women died from maternal cause worldwide which equates to about 800 maternal deaths per day or one every two minutes, yet the vast majority of these deaths were avoidable. In Uganda, the maternal mortality ratio is very high, estimated at 336 deaths per 100,000 live births.

This article is written by Dr. Matovu Richard and sponsored by Specialist Doctors International