Factors associated with the use of antenatal care in Sindh province, Pakistan: A population-based study

BACKGROUND: Antenatal care (ANC) is critical to decrease maternal and neonatal mortality. However, little is known about the utilization of ANC services in Pakistan. This study assessed the utilization of ANC in Sindh province, Pakistan, and identified the factors that affect its use. METHODS: We analysed a subset of data from Maternal and Child Health (MCH) Program Indicator Surveys conducted in Sindh province, Pakistan in 2013 and 2014. Respondents included 10,200 women who had given birth in the past two years. The outcome measure was making at least four ANC visits. Logistic regression models were used to identify demographic, socioeconomic, characteristics of ANC, and informational factors associated with ANC use. RESULTS: Most women (83.5%) received one or more ANC, mostly by doctors (95%), but only 57.3% of them made the recommended four or more visits, and just 53.7% received their initial ANC care during the first trimester. Making four or more ANC visits was associated with: fewer household occupants (odds ratio OR = 0.98; 95% confidence interval CI = 0.97, 0.99), large city residence (OR = 1.92; 95% CI = 1.57, 2.35), higher women's education (OR = 1.70; 95% CI = 1.33, 2.15), greater household wealth (OR = 5.66; 95% CI = 4.22, 7.60), and receiving MCH information from lady health worker (OR = 1.17; 95% CI = 1.00, 1.37), mother-in-law (OR = 1.17; 95% CI = 1.01, 1.36), other relatives/friends (OR = 1.19; 95% CI = 1.03, 1.38), or nurse/midwife (OR = 1.31; 95% CI = 1.06, 1.61). CONCLUSIONS: This study demonstrates that both socioeconomic factors and health information sources are associated with women's use of ANC. Therefore, programs should target socially disadvantaged and vulnerable groups, particularly rural, less educated, and poor women, to improve utilization of ANC. In addition, strategies to increase exposure to MCH information sources should be a priority in Sindh, Pakistan.