Catherine Arsenault|Keely Jordan|Dennis Lee|Girmaye Dinsa|Fatuma Manzi|Tanya Marchant|Margaret E Kruk
Equity in antenatal care quality: an analysis of 91 national household surveys
Harvard Global Health Institute|New York University|Harvard Global Health Institute|Haramaya University|Harvard Global Health Institute|Ifakara Health Institute|London School of Hygiene & Tropical Medicine|Harvard Global Health Institute
emerging data show many lowincome middleincome country lmic health systems struggle consistently provide goodquality care although monitoring inequalities access health services focus major international efforts inequalities healthcare quality systematically examinedusing recent 200716 demographic health surveys multiple indicator cluster surveys 91 lmics described antenatal care quality based receipt three essential services blood pressure monitoring urine blood testing among women least one visit skilled antenatalcare provider compared quality across country income groups quantified withincountry wealthrelated inequalities using slope relative indices inequality summarised inequalities using randomeffects metaanalyses assessed extent geographical sociodemographic factors could explain inequalitiesglobally 729 95 ci 691768 women used antenatal care reported blood pressure monitoring urine blood testing number ranged 63 burundi 1000 belarus antenatal care quality lagged behind antenatal care coverage lowincome countries 866 834897 women accessed care 538 443633 reported receiving three services receipt three services correlated gross domestic product per capita 40 percentage points higher uppermiddleincome countries compared lowincome countries within countries wealthiest women average four times likely report good quality care poorest relative index inequality 401 95 ci 390413 substantial inequality remained adjustment subnational region urban residence maternal age education number antenatal care visits 320 311330many lmics reached high levels antenatal care coverage much lower inequitable levels quality achieving ambitious maternal newborn child health goals require greater focus quality health services equitable distribution equity effective coverage used new metric monitor progress towards universal health coveragebill melinda gates foundation