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This Week in Managed Care: October 19, 2018
October 19, 2018

Quality Antenatal Care Lacking in Low-Income Countries

David Bai, PharmD
Patients in low-income countries receive similar antenatal care coverage as patients in high-income countries. However, they receive inequitable quality of antenatal care for 3 essential services: blood pressure monitoring, urine and blood tests, according to a study published in Lancet Global Health.
Patients in low-income countries receive similar antenatal care coverage as patients in high-income countries. However, they receive inequitable quality of antenatal care for 3 essential services: blood pressure monitoring and urine and blood tests, according to a study published in Lancet Global Health.

Healthcare has improved substantially across all countries and socioeconomic groups. However, the quality of care in low-income and medium-income countries remains poor. Good-quality antenatal care is essential in avoiding obstetric complications that may harm the mother and newborn. Infections and comorbidities must be addressed to improve maternal and newborn outcomes. The current study has described the antenatal care coverage and quality in diverse countries with varying incomes.

Patients who were examined as part of this study were women of reproductive age who had at least 1 live birth in the past 2 to 5 years. The 3 services that indicated quality of care and were analyzed in this study were blood pressure monitoring and urine and blood tests. The study included 671,697 women in 91 countries: 30 low-income, 35 lower middle–income, and 26 upper middle–income countries.

On average, antenatal care coverage was high, with 89.7% of women attending at least 1 antenatal care visit by a skilled provider. Although the coverage was high, only 72.9% of these women had a blood pressure check and a urine and blood test during their pregnancy. In low-income countries, 86.6% of patients received care, but only 53.8% of them reported receiving the 3 services. Patients in lower middle­–income countries reported similar care (87.8%), but a higher percentage of patients reported receiving the 3 services (74.8%). The percentage of patients in upper middle–income countries were even higher, with 96.1% receiving coverage and 93.3% receiving the 3 services.

The wealthiest women across all countries were 4 times as likely to receive the 3 services compared with the poorest women. This was especially pronounced when examining the low-income countries where the wealthiest women were 10 times as likely to receive the 3 services than the poorest women.

From this study, investigators concluded that there is a need to improve health outcomes in poorer countries as well as the patients with lower socioeconomic status. Health services should be equitable, and improvements should be made to remove the disparity among different income patients and countries.

Reference

Arsenault C, Jordan K, Lee D, et al. Equity in antenatal care quality: an analysis of 91 national household surveys. Lancet Glob Health. 2018;6(11):e1186-e1195. doi: 10.1016/S2214-109X(18)30389-9.

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