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Table of Contents
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 58-61

Universal health coverage in relation to antenatal care services and its correlates

1 Junior Resident, Lady Hardinge Medical College, New Delhi, India
2 Professor, Lady Hardinge Medical College, New Delhi, India
3 Country Project Manager, John Snow India Private Limited & Ex- Director Professor and Head, Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
4 Professor and Head Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India

Date of Submission19-Apr-2018
Date of Acceptance23-May-2018
Date of Web Publication1-Feb-2019

Correspondence Address:
Manish Kumar Goel
Professor, Department of Community Medicine, Lady Hardinge Medical College, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2395-2113.251351

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Introduction: Universal health coverage (UHC) means all people receiving the health services they need, of sufficient quality to be effective while at the same time ensuring that the use of these services does not expose the user to financial hardship. So, we did this study to assess the extent of UHC in relation to antenatal care services in Palam area of Delhi. Objectives: 1) To study the extent of coverage of antenatal services in Palam area of Delhi. 2) To assess the correlates of coverage of antenatal services among mothers. Material and methods: study type- a community based descriptive study was conducted between September 2015 to March 2017, among 250 mothers who delivered during the year 2015. A pretested, self-designed, semi-structured interview schedule and health records was used to collect information. Data was analysed using software – statistical package for social sciences (SPSS) version 20. Results: Out of 250 study participants, complete coverage of antenatal care services was seen in only 28.8% women. Literacy and presence of complication in previous pregnancy found to have statistically significant correlation with the extent of coverage of antenatal services. Conclusion: Women need to be educated about their health needs and services available to them, in order to increase the demand of maternal health services and improve utilization of available services.

Keywords: Universal health coverage, antenatal care services, correlates.

How to cite this article:
Sharma A, Goel MK, Bachani D, Rasania SK. Universal health coverage in relation to antenatal care services and its correlates. Indian J Community Fam Med 2018;4:58-61

How to cite this URL:
Sharma A, Goel MK, Bachani D, Rasania SK. Universal health coverage in relation to antenatal care services and its correlates. Indian J Community Fam Med [serial online] 2018 [cited 2021 Mar 7];4:58-61. Available from: https://www.ijcfm.org/text.asp?2018/4/1/58/251351

  Introduction Top

Universal health coverage (UHC) is about ensuring all people get the quality health services they need, without experiencing financial hardship.[1] Quality Maternal health services comprise of quality antenatal, natal and postnatal services.

Quality Antenatal services comprise of:

  • Ideal number of ANC visits (Ideal no. of visits is 11 or more and minimum recommended is 4 visits)
  • Quality services provided during those visits.

Maternal health refers to the health of women during pregnancy, childbirth and the post-partum period. Majority of the complications related to maternal health can be averted by preventive care (such as antenatal check-ups, birth preparedness), skilled care at birth, early detection of risk, appropriate and timely management of obstetric complications and postnatal care. The challenge lies in ensuring that this package is delivered at a sufficient scale and with sufficient quality to have a significant impact.[2] Studies from India have perpetually been manifesting the concern of inequities in utilization of maternal health care services.[3],[4]

The number of women dying due to complications during pregnancy and child birth has decreased by 43%.[5] The progress has been too slow to achieve the Sustainable Development Goal (SDG) of ending preventable maternal mortality.[6]

The key obstacle reported is pregnant women's lack of access to quality skilled care services.[2]

Universal health coverage has been emphasizing on providing not only the minimum health services but the adequate quality health services. And we need to move beyond the minimum maternal health services in order to achieve the SDGs targets of ending the preventable maternal and infant deaths. Still, most of the studies till now have been focussing on the coverage of only the minimum recommended maternal health services (i.e. 4 antenatal visits or not). So, we planned this in Palam area to assess the extent and quality of antenatal health services.

  Material and Methods Top

The present study is community-based cross- sectional study conducted between September 2015 to March 2017 among women in Palam area of Delhi which is a field practice area of the Department of Community Medicine Lady Hardinge Medical College, New Delhi. The area is well connected by public transport system. Majority of the families of the area belonged to upper lower or lower middle socio-economic class. Both public and private health care facilities cater to the health care needs of the residents. The government health services in the area are provided by Primary Health Centre, Palam under Central Health Service. The nearest referral centres of the area are Dada Dev Matri Evam Shishu Chikitsalaya, Dabri and Deen Dayal Upadhyay Hospital, Hari Nagar being the Community Health Centre and Tertiary Care Hospital of the area respectively. Nearby many private health facilities are also situated.

Assuming the prevalence of complete MCH coverage to be 45% (based on previous study findings), considering an allowable error of 15% and level of significance as 95%, and non -response rate of 15%, we had enrolled 250 women for the study.[7]

A list of all the deliveries that occurred in the year 2015, was made by combining the records obtained from multipurpose health workers of PHC Palam and Anganwadi workers in that area. Out of this list, 250 mothers were selected by simple random sampling using lottery method without replacement. Only those women who were residing in Palam area for >2 years were enrolled in the study.

The selected mother was interviewed by conducting house to house visit and information was recorded based on a pretested, self-designed, semi-structured interview schedule. Mothers were also enquired for the health facility records if available and the information gathered was cross checked and supported by these records.

Coverage of antenatal services:

Extent of ANC coverage was assessed as per the guidelines of Govt. of India, under the RMNCH+A Programme.

COMPLETE COVERAGE OF ANTENATAL SERVICES: A woman is considered to have complete coverage of antenatal services if she was registered within 12 weeks of gestation and received the recommended ideal number of ANC visits (11 or more along with first visit of registration) and quality antenatal service during those visits which includes-check-up, full dose of tetanus vaccination, adequate amount of iron folic acid tablets and all the routine investigations done during antenatal visits.

PARTIAL COVERAGE BUT ADEQUATE: A woman is said to have partial coverage but adequate if she received equal to or more than four (04) ante-natal visits and got all the essential components of antenatal care.

INADEQUATE COVERAGE: A woman is said to have inadequate coverage if she received less than four antenatal visits or did not receive all the essential components of antenatal care in any of those visits as recommended.

Also, the information regarding the reasons for not availing or inadequate services was obtained. Informed written consent was obtained from all the participants.

Data gathered was entered into a spreadsheet database created using Statistical Package for Social Sciences (SPSS version 20). Observations have been described in terms of mean, range and standard deviation for Continuous data and in terms of percentage / proportions for Categorical data. Regression analysis was done to identify the correlates of coverage of antenatal quality services.

  Results Top

Out of 250 women, only 28.8% had complete coverage of ANC services during their last pregnancy, 9.6% had inadequate coverage (6 women did not receive any antenatal care) and more than half i.e. 61.6% had partial but adequate coverage. Weight and Blood Pressure was recorded during each ANC visit in majority of women i.e. around 90%. Almost all i.e. 97.6%, got the full dose of Tetanus Toxoid vaccination.

Only half of the study subjects i.e. 55.2% took IFA adequately. Among anaemic women, only (40.8%) took Iron folic acid adequately whereas among non- anaemic, 73.1% women took IFA tablets adequately [Table 2]. Nearly 90% of women got tested for Blood group, HIV, VDRL and HbsAg whereas as per recommendation investigations like Blood sugar, Urine routine microscopy, USG and Haemoglobin testing was done twice in only 54%, 50.4%, 64% and 74% respectively [Table 3].
Table 1: Distribution by coverage of quality ANC and PNC visits (n= 250)

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Table 2: Distribution by coverage of quality ANC services during ANC visits (n=250)

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Table 3: Distribution by investigations done among study subjects during ANC visits (n=250)

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Findings of our study showed that lack of knowledge was the main reason in majority of the women (52.8%) who did not avail the complete antenatal care. This was followed by long waiting lines in the government health facilities as the reason for 14.6% women and 14 (5.6%) women said that they had no one to accompany for their antenatal visit. Whereas rude behaviour of the health personnel, lack of time, ignorance, financial reasons and religious beliefs were also reasons for some women for inadequate ANC care. [Table 4].
Table 4: Reasons/Barriers for partial or non-coverage of ANC services (n=178)

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Among the various factors studied, literacy and presence of complication in previous pregnancy were found to be statistically significant correlates for utilisation of antenatal care services [Table 5].
Table 5: Determinants of utilization of antenatal health services among study subjects (n=250)

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  Discussion Top

In the present study, it was observed that majority of women i.e. 90.4% either partial or complete received antenatal care. Our findings were comparable with similar findings of around 90% coverage of any form of antenatal care in India and Brazil.[8],[9],[10],[11] In contrast, less utilization of antenatal services also been reported in rural north India and Bangladesh with 40.3% and 48% utilization rate respectively.[12],[13] High level of coverage was seen in our study population located in the Capital, as it has access to adequate number of facilities providing good antenatal services.

Majority of the studies assessed only the minimum number of antenatal visits and women receiving the minimum services ranged between 51.2% - 81.5%.[9],[10],[14],[15] Whereas studies had also been reported from different areas of India and Bangladesh showing very less ANC utilization i.e. only 41.4%, 10.5% and 33.7% women receiving more than 3 antenatal visits.[17] The main reason revealed for poor antenatal utilization was unsatisfactory behaviour of health staff as well as lack of trained health care professionals.

Some other researchers have taken full antenatal care as at least three or four antenatal visits, tetanus toxoid and iron folic acid tablets or syrup taken for 100 or more days and found that in Nepal and India, the coverage was 21%, 24.7% and 29.1%.[15],[16],[19]

Present study assessing the complete coverage showed that only 29% women received complete coverage, 61.6% partial but adequate and 9.6% inadequate antenatal services.

Different researchers reported different barriers in utilization of ANC services. Unsatisfactory behaviour of health staff and lack of trained health care professionals was reported in India, Bangladesh and Nepal.[16],[17],[18],[19] Other barriers reported were lack of perceived need, long waiting time, lack of time, cost of service and also distance to health facility reported.[19],[20],[21] These barriers were also reported in our study.

  Conclusion Top

As the complete coverage is seen in only 29% of mothers, rather than focussing only on minimum antenatal services, the effort should be made to improve the coverage of complete ANC services to achieve the SDGs goal of UHC. Different barriers should be addressed properly to achieve the target of universal coverage of maternal health services. Regular reorientation and training programs should be organized for the health workers to have the trained health staff. Women need to be educated about their health needs and services available to them, in order to increase the demand of maternal health services and improve utilization of available services. Up-gradation of existing PHCs and CHCs is need to be done to address the issue of long waiting lines and huge rush at public health care facilities. So, we need to provide good quality services at public health facilities Also provision of health insurance should be made to address the issue of cost as a barrier.

  References Top

Universal health care. United Nations in India. [Internet] Available from: http://www.in.one.un.org/task-teams/universal-health- coverage 2013 [cited 2017 April 5]  Back to cited text no. 1
MoHFW, GOI. A strategic approach to reproductive, maternal, newborn, child and adolescent health (RMNCH+A) in India. New Delhi: Ministry of health and family welfare, GÜI;2013.18p.  Back to cited text no. 2
Baru R, Acharya A, Acharya S, Kumar AS, Nagaraj K. Inquities access to health services in INDIA: caste, class and region. Econ Politic Wkly.2010; 45(38): 49-58.  Back to cited text no. 3
Kumar C, Prakash R. Public- private dichotomy in utilization of health services in INDIA. Consilience J Sustain Dev. 2011;5(1):25- 52.  Back to cited text no. 4
Global Health Observatory Data, Maternal mortality [Internet].2017 [cited 2017 Mar 19]. Available from: http://www. who.int/gho/maternal_health/mortality/maternal_mortality_ text/en/  Back to cited text no. 5
Trends in maternal mortality: 1990 - 2015 [Internet]. 2017 [cited2017Mar19]. Available from: http://www.who.int/ reproductivehealth/publications/monitoring/maternal- mortality-2015/en/  Back to cited text no. 6
Kumar C, Singh PK, Rai RK. Coverage gap in maternal and child health services in India: assessing trends and regional deprivation during 1992-2006. See comment in PubMed Commons below J Public Health. 2013;35(4):598-606.  Back to cited text no. 7
Lindsay AC, Dubowitz T, Andrade FM, Campos JS, Peterson KE: Maternal Health Care Services in the State of Ceará, Northeast Brazil. Women's Health Urban Life. 2007, 6 (2): 68-70.  Back to cited text no. 8
Agarwal N, Galhotra A, Swami HM. A study on coverage utilization and quality of maternal care services. National J Community Med. 2011;2(1):32-6.  Back to cited text no. 9
Coverage Evaluation Survey National Factsheet [Internet].2009 [cited 2017 Apr 2]. Available from: http://hshrc.gov.in/wp- content/uploads/National_Fact_Sheet_CES_2009.pdf  Back to cited text no. 10
Rao KM. Utilization of reproductive and child health services in tribal areas of Andhra Pradesh. Tribes and Tribals. 2008; 2:35-41.  Back to cited text no. 11
Ansari MA, Khan Z. Antenatal care services in rural areas of Aligarh, India: A cross-sectional study. J Public Health Epidemiol. 2011;3(5):210-16.  Back to cited text no. 12
Koenig MA, Jamil K, Streatfield PK, Saha T, Al-Sabir A, Arifeen SE, Hill K, Haque Y. Maternal health and care-seeking behaviour in Bangladesh: findings from a national survey. IntFam Plan Perspect. 2007;33(2):75-82.  Back to cited text no. 13
Fagbamigbe AF, Idemudia ES. Assessment of quality of antenatal care services in Nigeria: evidence from a population-based survey Reprod Health. 2015;12(1):88.  Back to cited text no. 14
National Family Health Survey-4 [Internet]. 2015-16 [cited 2017 Apr 5]. Available from: http://rchiips.org/NFHS/pdf/NFHS4/ India.pdf  Back to cited text no. 15
Sahni B, Sobti S. Utilization of antenatal care among pregnant females registered at sub centre level in a rural area of Jammu in India. Int J Healthcare Biomed Res. 2013;1(4):269-78.  Back to cited text no. 16
Mansur AM, Rezaul KM, Mahmudul HM. Quality of antenatal care in primary health care centers of bangladesh. J Family Reprod Health. 2014;8(4):175-81.  Back to cited text no. 17
Singh JP, Kariwal P, Gupta SB, Shotriya VP, Singh PN. Utilization of antenatal care services in a rural area of Bareilly. Int J Healthcare Biomed Res. 2014;2(3):120-26.  Back to cited text no. 18
Dhakal S, Van Teijlingen ER, Stephens J, Dhakal KB, Simkhada P, Raja EA et al. Antenatal care among women in rural Nepal: a community-based study. Online J Rural Nurs Health Care. 2011;11(2):76-87.  Back to cited text no. 19
Pal S, Mahapatra BS, Mukhopadhyay DK, Sinhababu A, Soren AB, Biswas AB. Coverage of ante-natal care in a block of West Bengal using lot quality assurance sampling. Indian journal of public health. 2009 Oct 1;53(4):256.  Back to cited text no. 20


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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