Impact of Frequency and Timing of Antenatal Care Visits on Neonatal - PDF document

Impact of Frequency and Timing of Antenatal Care Visits on Neonatal mortality in EAG states Rishabh Gupta, Research scholar, IIPS Introduction: Of the global, annually 5.9 million child deaths in 2015, nearly half of child deaths were neonatal deaths. In the same year, near to forty-five percent of under-five deaths occurred during their first month of life (WHO, 2015). Approximately 75% of neonatal deaths occur in the early-neonatal period, or the first 7 days after delivery and 50% occur in the first 24 hours. Sustainable development goal (SDG) no.3 targets to reduce under-five mortality to 25 child death per 1000 live births by 2030. The achievement of goal is impossible unless until countries with high child mortality manage to reduce their neonatal mortality due to that fact that a substantial proportion of under-five mortality occurs during neonatal period. Neonatal mortality in India has reduced from 75 deaths per thousand live births in 1971 to 25 deaths per thousand live births in 2015(SRS, 2015). Still neonatal mortality rates are quite high in India. Therefore, interventions to reduce the number of neonatal deaths are important in India. According to Paul and Beorari, factors contributing to the high newborn mortality rates in South Asia include widespread low birth weight, lack of skilled health care at birth, and low levels exclusive breastfeeding in the initial month of life. According to WHO, many health problems in pregnant women can be prevented, detected and treated during antenatal care visits with trained health workers soall pregnant women should avail at least four antenatal visits, with the first antenatal visit, preferably in the first trimester (WHO 2006). Further guideline suggests that every pregnant woman must consume 90 or more IFA tablets and must receive at least two tetanus toxoid injections (Maternal Health Division 2005). According to Indian government guidelines, every pregnant should avail for 3 or more antenatal care visits along with 90 or more IFA tablets and 2 or more TT injections. ANC visits are crucial for providing counseling to mothers about the care they should take during pregnancy and also in preparation for childbirth. Antenatal care visits can be used to provide tetanus immunization, malaria prophylaxis, iron and folic acid tablets, and nutrition education. Such counseling can play a significant role in averting morbidity and mortality of both mother and newborn. We also found in a study that the risk of low birth weight and neonatal and infant mortality has been shown to be higher for mothers making fewer antenatal visits (Hemminki E. et al. 1993). The main component of antenatal care visit is to offer information and advice to women about pregnancy related complications and possible curative measures for early detection. Specific components which can significantly reduce maternal and neonatal mortality include iron supplementation, tetanus toxoid immunization, early detection and treatment of pre-eclampsia, preparation for transportation to a delivery site, and safe delivery education among others. Furthermore antenatal visits may raise awareness about the need for care during delivery or give women and their families a familiarity with health facilities that enables them to seek help more efficiently during a crisis. Actually antenatal care visits could be considered as starting point of entering in healthcare centres.

Regular antenatal care is important for identifying women at increased risk of adverse pregnancy outcomes (World Health Organization, 1994). Timing of first antenatal visit is important for pregnant women. First visit includes weight, blood pressure, Urine test, blood test of pregnant women for better health outcome of baby and mother. Overall the basic contents of antenatal care programmes include history taking, abdominal palpation, blood pressure and maternal weight measuring. Other components include laboratory tests such as a test for syphilis and blood group typing. According to health experts, women go for three first check- up around the 8 th to 12 th week of pregnancy. After that, they would need to go every 4-6 weeks until 28 weeks of gestation and then every week until the baby arrives (usually at 40 weeks). Low frequency of visits or late timing of the first antenatal visit is undesirable because they limit the amount and quality of care that a pregnant woman receives. The study by Coria-Soto et al. (1996), found that an inadequate number of visits was associated with 63% higher risk of intra uterine growth retardation. Our study based on eight empowered action group states namely, Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Orissa, Rajasthan, Uttar Pradesh and Uttarakhand, and Assam also which have lagged behind in containing population growth to manageable levels. In these states, the prevalence of ANC visits are low and those states constitute a large proportion of the population of India. So we want to analyze the association between frequency of antenatal visits and neonatal mortality and also want to establish a relationship between timing of first antenatal visit and neonatal mortality in these states. Survey of literature: Neonatal mortality refers to death during the first 28 days after birth. Approximately 70% of neonatal deaths occur in the first six days and an unexpected low proportion of early neonatal deaths could be a result of under-reporting deaths in this age group (Boerma, 1988; Curtis, 1995). A study carried out by Carroli et al. (2001) also showed a lack of strong evidence on the effectiveness of the content, frequency and timing of visits in standard ANC programs in maternal and child health. Recent studies in developing countries reported that infections (e.g. sepsis/pneumonia, tetanus and diarrhea) and preterm delivery were major contributors to neonatal mortality (Yasmin et al., Ngoc et al.). Indonesia demographic and health survey for 2002–2003, confirmed that antenatal care and postnatal care services decreased neonatal mortality. Antenatal care (ANC) is an important determinant of safe delivery (Bloom et al. 1999). Although certain obstetric emergencies cannot be predicted through antenatal screening, women can be educated to recognize and act on symptoms leading to potentially serious conditions (Bhattia & Cleland 1995); this is one strategy for reducing maternal mortality (Nuraini & Parker 2005). One of the most important functions of ANC is to offer health information and services that can significantly improve the health of women and their infants (WHO & UNICEF 2003). In addition, ANC during pregnancy appears to have a positive impact on the utilization of postnatal healthcare services (Chakraborty et al. 2002). Empirical evidence shows that four visits are sufficient for uncomplicated pregnancies and more are necessary only in cases of complications (Villar et al. 2001); Hence the World Health Organization currently recommends at least four ANC visits in the course of pregnancy. In a study, we found that Bloom, Lippeveld and Wypij (1999) used a weighted score of the various components of antenatal care and visit frequency in Uttar Pradesh, India. They found that women who had received a high level of antenatal care were about 4 times as likely to use trained