| Indicator ID | H3 |
|---|---|
| Indicator full statement | # of pregnant women who attended at least four antenatal care consultations provided by skilled healthcare workers. |
Purpose
| Importance | This indicator provides insights into the utilization of Antenatal Care (ANC) services at the recommended level (at least four consultations) and can be used to track trends in utilization where Tdh conducts related health activities. ANC visits are linked to better health outcomes for both the mother and the foetus / newborn. This service is essential for preventing, detecting, and treating maternal health problems and is critical for foetal monitoring. |
|---|---|
| ToC pathway | It aligns with Tdh's Theory of Change, contributing to local health systems, communities, and families. It is used where Tdh is providing the service. |
| Related services | This indicator can be linked to the use of Tdh’s SIMSONE project. |
Definition
The proportion of women who had, within a given period, attended Antenatal Care (ANC) provided by skill healthcare workers four or more times during their most recent pregnancy.
The World Health Organisation (WHO) has recommended a standard model of four antenatal visits which include (non-exhaustive list) clinical examination, tests for infections, maternal health monitoring, preventive care like iron supplementation and tetanus immunization, and recommendations for emergencies.
How to collect & analyse the data
| What do we count? | Women with a live birth in a given time period who received antenatal care four or more times |
|---|---|
| Data sources | See Indicator H 1 Births assisted by skilled birth attendants (outcome). |
| Data collection methods and tools |
|
| Disaggregation | Data should be disaggregated by
Where appropriate depending on the data source. |
| Important considerations | Frequency and timing: Population based surveys: project baseline then biennial (every 2 years). More frequent surveys are probably not desirable because the survey periods may overlap, and sampling error makes it difficult to assess changes. Routine data sources: monthly, quarterly, and annual monitoring at delegation level. |
Limitations and precautions
This indicator does not measure the timing, reason, nor quality of any of the ANC visits. Therefore, it does not guarantee that women received all the recommended and necessary interventions. However, at least four ANC visits increase the likelihood of receiving the full range of interventions.
Facility-based data might miss pregnancies managed outside the public health system (i.e., private and community) and over or underestimate the coverage in case of changes in number of stillbirth and/or abortion rates within the population.
With population-based surveys, recall error is also a potential source of bias.
What further analysis are we interested in?
To understand ANC coverage, it is useful to analyse the availability of service (i.e., if Tdh is supporting ANC services in that specific area), the accessibility and acceptability (i.e., if the pregnant women can access the health facility supported by Tdh, considering distance, costs, security and social barriers), and the utilization of services (i.e., actual coverage, considering the ANC minimal package and target population).
Cross-analysing this indicator with information on the number of skilled birth attendants (SBA) directly or indirectly trained by Tdh along with the availability of a referral system, gender norms and other sociocultural factors when context relevant, will help in the interpretation.
Additional guidance
Resources: Under the technical assistance of HQ, Tdh M&E and operational teams in each delegation should work closely with health authorities to collect and interpret the data. Countries with limited resources to conduct household surveys, should consider using a consultant or facility-based estimates, though less reliable can provide interim insights.
Countries with limited health system infrastructure may consider partnerships with international organizations (e.g., WHO, UNICEF) and academic institutions to support capacity-building for data collection and antenatal care service delivery.
Indicator global monitor and strategies:
WHO Library Cataloguing-in-Publication Data, Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice – 3rd ed., 2015, I.World Health Organization. II.UNFPA. III.UNICEF. IV.World Bank, ISBN 978 92 4 154935 6 (NLM classification: WQ 176). Available at: https://web.archive.org/web/20201030093023/https://apps.who.int/iris/bitstream/handle/10665/249580/9789241549356-eng.pdf;jsessionid=7B8E18468A424E0301261B2CA6BCB324?sequence=1 (Accessed: 30 September 2024)
WHO recommendations on antenatal care for a positive pregnancy experience, 2016, World Health Organization. Available at: https://www.who.int/publications/i/item/9789241549912 (Accessed: 30 September 2024).