Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries.

Background: Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs). Methods and findings: We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes. Conclusions: Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality. Leveraging data from demographic health surveys across the globe, Boshen Jiao and co-authors explore how adequate antenatal care influences health-seeking behaviors more generally. Author summary: Why was this study done?: Antenatal care is essential to the well-being of pregnant women and their fetuses. Previous research shows that the frequency of antenatal care visits can significantly influence health behaviors of both mothers and their children. Existing studies center on a limited set of countries, leading to a notable gap in our understanding of the potential broader health system impact that antenatal care can have. What did the researchers do and find?: We modeled the association between achieving adequate antenatal care and various health indicators across wealth quintiles in 47 low- and middle-income countries using data from Demographic and Health Surveys collected between 2010 and 2022. The model estimated the projected impact of achieving adequate antenatal care utilization and quality on facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. We found that achieving adequate levels of antenatal care utilization and quality was positively associated with health-seeking behavior of mothers across most countries. The stronger associations were observed in countries with lower baseline antenatal care utilization levels and among lower wealth quintiles. What do these findings mean?: Strengthening antenatal care could potentially improve the use of other health care in low- and middle- income countries. Antenatal care could serve as a critical platform for improving broader health outcomes for mothers and their children, emphasizing its importance beyond the direct impact on maternal and neonatal health. Despite rigorous adjustments for potential confounders, a limitation of the methodology is the possibility that unobserved variables may still impact the outcomes. [ABSTRACT FROM AUTHOR]