Examining the impact of WHO’s Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi : a retrospective study
Date
2019-05-08
Journal Title
Journal ISSN
Volume Title
Publisher
BMC (part of Springer Nature)
Abstract
Background: A variety of antenatal care models have been implemented in low and middle-income countries over
the past decades, as proposed by the World Health Organisation (WHO). One such model is the 2001 Focused
Antenatal Care (FANC) programme. FANC recommended a minimum of four visits for women with uncomplicated
pregnancies and emphasised quality of care to improve both maternal and neonatal outcomes. Malawi adopted
FANC in 2003, however, up to now no study has been done to analyse the model’s performance with regards to
antenatal care service quality and utilisation patterns.
Methods: The paper is based on data pooled from three comparable nationally representative Malawi Demographic
and Health Survey (MDHS) datasets (2000, 2004 and 2010). The DHS collects data on demographics, socio-economic
indicators, antenatal care, and the fertility history of reproductive women aged between 15 and 49. We pooled a
sample of 8545 women who had a live birth in the last 5 years prior to each survey. We measure the impact of FANC
on early access to care, underutilisation of care and quality of care with interrupted time series analysis. This method
enables us to track changes in both levels and the trends of our outcome variables.
Results: We find that FANC is associated with earlier access to care. However, it has also been associated with
unintended increases in underutilisation. We see no change in the quality of ANC services.
Conclusion: In light of the WHO 2016 ANC guidelines, which recommend an increase of visits to eight, these
results are important. Given that we find underutilisation when the benchmark is set at four visits, eight visits
are unlikely to be feasible in low-resource settings.
Description
CITATION: Mchenga, M., Burger, R. & Von Fintel, D. 2019. Examining the impact of WHO’s Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi : a retrospective study. BMC Health Services Research, 19:295, doi:10.1186/s12913-019-4130-1.
The original publication is available at https://bmchealthservres.biomedcentral.com
The original publication is available at https://bmchealthservres.biomedcentral.com
Keywords
World Health organization -- Focused Antenatal Care Model, Prenatal care -- Effectiveness -- Malawi, Maternal health services -- Effectiveness -- Malawi
Citation
Mchenga, M., Burger, R. & Von Fintel, D. 2019. Examining the impact of WHO’s Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi : a retrospective study. BMC Health Services Research, 19:295, doi:10.1186/s12913-019-4130-1