Antenatal Visit Coverage – Four Visits

A range of health problems experienced by pregnant women and their babies can be prevented and detected through frequent antenatal checks by skilled or unskilled providers. The indicator therefore assesses the proportion of women who attended antenatal visits at the level recommended by WHO.

Collect the following data by conducting individual interviews with a representative sample of women aged 15 – 49 who in the past 2 years delivered a live child:

RECOMMENDED SURVEY QUESTIONS (Q) AND POSSIBLE ANSWERS (A)

Q1: During the pregnancy with your youngest child, did anyone check your and your baby’s health?

A1: yes / no

(ask the following question only if the previous answer is YES)

Q2: During the pregnancy with your youngest child, how many times did either a member of health facility staff, health volunteer or traditional birth assistant check your and your baby’s health?

A2: once / twice/ three times / four times / five times / six times/ seven times/ eight times / does not remember

Calculate the indicator’s value by dividing the number of respondents who attended at least four or more antenatal checks by the total number of interviewed respondents (exclude those who did not remember) and multiplying the result by 100.

Disaggregate the data by location (rural/urban; near a health facility/far from a health facility), socio-economic characteristics (wealth quintile, education level) and mother’s age.

1) Use the following two questions to assess whether the respondent is “aged 15 – 49 years and had a live birth in the last 2 years”:

Q: What is your age?

A: specify: ______ / won’t say

Q: In the past two years, did you give birth to a child that was alive when it was born?

A: yes / no / won’t say

2) In late 2016, WHO increased the recommended number of antenatal visits from four to eight (see link below). Since different countries are likely to have a different pace of adopting this recommendation (and having capacity to implement it), set the minimum number of antenatal visits based on the local Ministry of Health's official recommendations.

3) The two indicators of antenatal care (at least one visit and at least four visits) are based on WHO’s standard questions. While the “one visit” indicator focuses on the quality of care (i.e. care provided by a skilled health professional), the “four visits” indicator focuses on the intensity of care (given by either skilled or unskilled provider). Since most national surveys do not collect information on type of provider for each visit, WHO does not measure the number of visits provided by skilled health personnel. See more details in WHO’s guidance.

4) If you need to know exactly who the respondent visited for antenatal care, you will have to ask about each visit individually (i.e. Who did you see during the first visit? etc.). However, this should be assessed only if you interview mothers of children aged 0 – 12 months who are more likely to remember who they saw.

5) Consider assessing also when the first visit took place by asking: "How many months pregnant were you when you first received antenatal care for your pregnancy with your youngest child?"

6) If you are interested in the gender dimension of accessing antenatal care, consider asking: During your pregnancy with your youngest child, did your partner ever come with you to an antenatal care visit?

7) The indicator is based on UNICEF’s Multiple Indicator Cluster Survey (MICS) guidance.