Measuring quality of antenatal care: a secondary analysis of national survey data from India

OBJECTIVE: To assess the coverage and adequacy of antenatal care services (ANC) available to women and examine the socio-economic determinants affecting service utilisation. DESIGN: Secondary data analysis of a population-based national survey. SETTING: India, 2015/16. SAMPLE: In all, 190 898 women between 15 and 49 years of age who had a live birth during the 5 years preceding the survey. METHODS: Ordinal logistic regression. MAIN OUTCOME VARIABLE: Adequacy of ANC services received was measured under four categories - delivery of services by skilled personnel, timely provision of services, sufficiency and appropriateness of content. Quality of care was categorised as adequate ANC, inadequate ANC and no ANC. RESULTS: Only 23.5% (95% CI 23.1-23.9%) of all women received adequate ANC, while 58.8% (95% CI 58.4-59.2%) received inadequate and 17.7% (95% CI 17.4-18.0%) received no ANC services. Regression analysis revealed that women belonging to the adolescent age group, illiterate women, and those in the poorest wealth quintile and in rural areas were less likely to receive any ANC. CONCLUSION: There is a need to improve the quality of ANC services. Currently, <25% of women of all ages receive adequate ANC. Socio-economic conditions play a vital part in determining the quality of care that women receive. TWEETABLE ABSTRACT: Nearly one out of four women in India received adequate ANC, nearly three in every five women received inadequate ANC and 18% lacked ANC for their recent live birth.