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, which can include treatment of hypertension to prevent eclampsia, tetanus immunization, intermittent preventive treatment for malaria and distribution of insecticide-treated mosquito nets, 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 also provides an opportunity to supply information on 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. According to WHO guidelines, antenatal care visits should include, at a minimum, the measurement of blood pressure, testing of urine for bacteriuria and proteinuria, and blood tests to detect syphilis and severe anaemia. 

High levels of antenatal care coverage across the developing world

According to the latest estimates, 78 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 a low of 68 per cent in South Asia to a high of 95 per cent in Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS). In addition to CEE/CIS, more than 9 in 10 pregnant women are attended at least once in Latin America and the Caribbean and in East Asia and the Pacific.

               
Source: MICS, DHS and other national surveys, 2003-2008.

Overall, levels of ANC remain high regardless of place of residence. For example, two thirds of women living in rural areas receive ANC at least once from a skilled health professional. Nonetheless, there is a substantial differential – whereas 67 per cent of rural women receive ANC from a skilled professional, 89 per cent of urban women benefit from this care.

Coverage of four or more ANC visits must be improved

Less than half of all pregnant women in developing countries benefit from the minimum recommended four antenatal visits. In South Asia, just one third of pregnant women receive care at least four times. Importantly, these antenatal care data do not reflect the quality of care, which is difficult to measure. Nonetheless, it is essential to ensure the quality of antenatal care so that services provided contribute to improved maternal health.

Although ANC coverage is high, less than half of women in developing world receive recommended minimum of four visits
Percentage of women attended at least four times during pregnancy by any provider