Assessing the association between an early and recommended number of focused antenatal care visits and the number of prenatal care content received before delivery in Ethiopia

BACKGROUND: Early and frequent antenatal care (ANC) has been linked to better pregnancy outcomes. This study assessed whether having at least four ANC contacts was associated with increased prenatal care content if the first visit was started in the first trimester in Ethiopia. METHODS: Data from the 2019 Ethiopia Mini Demographic and Health Survey on 2894 women aged 15-49 who received ANC during their last pregnancy were analyzed. The sum of women's responses to six questions about ANC components (blood pressure taken, urine sample taken, blood sample taken, provided or bought iron tablet, counselling by a health worker on nutrition, and told about pregnancy complications) was used to construct a composite score of routine ANC components. The main predictor was a combination of the timing of the first contact and the number of ANC contacts before birth. RESULTS: We found that 28.7% of women who began ANC early made at least four ANC contacts. More than one-third (36%) received all six components, with blood pressure monitoring being the most common (90.4%). After adjusting for potential confounding factors, women who had at least four contacts and booked early were substantially more likely than their counterparts to get a factor-of-one increase in the number of components received (IRR = 1.08; 95% CI: 1.03, 1.10). CONCLUSION: We found a strong association between increased prenatal care content and early ANC with at least four contacts. However, less than a third of women in the study setting had at least four contacts, with the first occurring in the first trimester. In addition, less than half of women received essential prenatal care interventions before delivery. The findings suggest that the WHO's new guidelines for ANC frequency and timing may be challenging to implement in some countries, such as Ethiopia, that already have low coverage of four or more contacts. If the recommendations are adopted, effective strategies for increasing early starts and increasing contacts are required.