Special emphasis must be placed on antenatal and post-natal care, essential obstetric care and care for newborns, particularly for those living in areas without access to services	Target 5.B: Achieve, by 2015, universal access to reproductive health

The challenge

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.

Regular contact with a doctor, nurse or midwife allows health personnel to manage the pregnancy and provide a variety of services, such as treatment of hypertension to prevent eclampsia; tetanus immunization; intermittent preventive treatment for malaria and distribution of insecticide-treated mosquito nets (in malaria endemic settings); prevention of mother-to-child transmission of HIV; micronutrient supplementation; and birth preparedness, including information about danger signs during pregnancy and childbirth. The antenatal period is also an ideal opportunity to supply information on future birth spacing, which is recognized as an important factor in improving infant survival.

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.

Antenatal care is common across the developing world

According to the latest estimates, 80 per cent of women in the developing world receive antenatal care (ANC) from a skilled health provider at least once during pregnancy. Regional averages range from around 70 per cent in South Asia and West and Central Africa to over 90 per cent in Latin America and the Caribbean, Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS), and East Asia and the Pacific.

               
Source: UNICEF global databases 2011, from Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative sources.
Note: Global estimates are based on a subset of 134 countries, covering 93% of births in the developing world. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS and industrialized countries.

Coverage of the recommended minimum of four or more antenatal care visits is still too low in developing countries 

Just over half of all pregnant women in developing countries receive the minimum recommended four antenatal visits. The data do not, however, reflect the quality of care, which is difficult to measure. It is essential to ensure a high quality of antenatal care so that services provided actually contribute to improved maternal health.

Although antenatal care coverage is high, just half of women in the developing world receive the recommended minimum of four visits
Percentage of women attended at least four times during pregnancy by any provider, 2006–2010

Source: UNICEF global databases 2011, based on MICS, DHS and other national surveys.
Notes: Global estimates are based on a subset of 74 countries, covering 66% of births in the developing world. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS and industrialized countries.
* Excludes China.

Substantial improvements in antenatal care coverage since 1990

During the past two decades, every region has made substantial progress in extending coverage of antenatal care for women at least once during pregnancy by skilled health providers. South Asia and East Asia and the Pacific experienced the largest improvements during this time period, each with about a 20 percentage-point increase.

Antenatal care coverage has improved in every region
Percentage of women attended at least once during pregnancy by a doctor, nurse, midwife or auxiliary midwife, 1990–2010 

Source: UNICEF global databases 2011, based on MICS, DHS and other national surveys.
Notes: ‘1990’ refers to 1990–1999 period, and ‘2010’ refers to the latest data available for the period '2006–2010'. Global estimates are based on a subset of 91 countries, covering 88% of births in the developing world. Regional estimates represent data from countries covering at least 50% of regional births. Data coverage was insufficient to calculate the regional average for CEE/CIS and industrialized countries.
Regional aggregates presented within trend charts may differ from the latest regional estimates presented elsewhere. In analyzing trends, the same subset of countries must be included in the calculation for each point in time. This can yield a different result from the latest regional estimates, which is calculated using all available data for the most recent year.

References

UNICEF, The State of the World’s Children 2012, UNICEF, New York, 2012 (forthcoming).

UNICEF, Progress for Children: A report card on maternal mortality, Report No. 7, UNICEF, New York, 2008.

UNICEF/WHO, Antenatal Care in Developing Countries: Promises, achievements and missed opportunities, WHO, Geneva, 2003.

The Partnership for Maternal, Newborn and Child Health, Strategy and Workplan 2009 to 2011, WHO, Geneva, 2009.