INEQUALITIES IN ANTENATAL CARE COVERAGE AND QUALITY IN 63 LOW AND MIDDLE-INCOME COUNTRIES

Objective: To conduct a global analysis of socioeconomic inequalities in antenatal care (ANC) using national surveys from low- and middle-income countries. Methods: We measured ANC using the ANCq, a novel content-qualified ANC coverage indicator, created and validated using national surveys, based upon contact with the health services and content of care received. We stratified ANCq by household wealth quintiles, place of residence, woman’s education, and woman’s empowerment in each country to explore the socioeconomic inequalities in ANCq. We also estimated the slope index of inequality (SII), which measures the difference in coverage along the wealth spectrum. Results: We analyzed 63 national surveys with available data. There were large inequalities between and within countries. Higher ANCq scores were observed among women living in urban areas, with secondary or more level of education, belonging to wealthier families and with higher empowerment scores in nearly all countries. In general, countries with higher ANCq mean presented lower inequalities; while countries with average ANCq scores presented wide range of inequality, with some managing to achieve very low inequality. Conclusions: Despite all efforts in ANC programs, important inequalities in coverage and quality of ANC services persist. If maternal and child mortality Sustainable Development Goals are to be achieved, those gaps we documented have to be bridged.