Antenatal Visit Coverage – Four / Eight 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 the recommended number of antenatal visits.

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 / more times / does not remember

To calculate the indicator’s value, you first need to determine whether the country's Ministry of Health promotes four antenatal checks (which was WHO's recommendation before 2016) or eight antenatal checks (which is WHO's recommendation since 2016; see link below). You should then divide the number of respondents with at least the minimum number of antenatal checks by the total number of interviewed respondents (excluding those who did not remember). Multiply the result by 100 to convert it to a percentage. 

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; page 105). Since different countries are likely to have a different pace of adopting this recommendation (and having the 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 eight 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 “eight visits” indicator focuses on the intensity of care (given by either skilled or unskilled provider). Since most national surveys do not collect information on the type of provider for each visit, WHO does not measure the number of visits provided by skilled health personnel.

4) 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?"

5) If you are interested in the gender dimension of accessing antenatal care, consider asking: Did your partner ever attend an antenatal care check with you during your pregnancy with your youngest child?

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