Multilevel Negative Binomial Analysis of Factors Associated with Number of Antenatal Care Contacts in South and Southeast Asian Countries: Evidence from Demographic and Health Surveys

Background: Antenatal care (ANC) is care provided by skilled health-care professionals that can reduce maternal and child mortality, prevent disease, and manage pregnancy-related diseases. Although increasing uptake of ANC is the focus of the 2016 updated WHO recommendations on ANC for a positive pregnancy experience, South and Southeast Asian countries (SSEA) account for insufficient ANC attendance. Therefore, this study focused on exploring factors associated with the number of ANC contacts in the SSEA countries.

Methods: Recent Demographic and Health Surveys (DHS) data from eleven SSEA countries, conducted between 2015 and 2022, were analyzed. A total of 93,125 mothers aged 15-49 years who gave birth in the last five years preceding the survey were included in the analysis. A multilevel negative binomial regression analysis was used to identify independent predictors of ANC contacts. Adjusted incidence rate ratios (AIRR) were reported to show association.

Results: Only 24% of the mothers in the eleven SSEA received WHO-recommended eight or more ANC contacts, and 13 out of 100 mothers didn’t receive any ANC services in these countries. This study revealed that mothers (AIRR = 1.53, 95% CI: 1.51 – 1.55) and their partners (AIRR = 1.35, 95% CI: 1.33 – 1.37) with higher educational attainment, mothers aged ≥35 (AIRR = 1.32, 95% CI: 1.30 – 1.34), mothers having autonomy to make decisions (AIRR = 1.13, 95% CI: 1.12 – 1.14), mothers exposed to media (AIRR = 1.18, 95% CI: 1.17 – 1.20), urban dwellers (AIRR = 0.88, 95% CI: 0.86 – 0.89), women from female headed households (AIRR = 1.09, 95% CI: 1.07 – 1.10) and mothers from rich households (AIRR = 1.06, 95% CI: 1.05 – 1.08) had significantly higher number of ANC contacts. However, mothers from rural areas, mothers with more than one birth order, mothers from families having more members, and working husbands were significantly associated with a lower number of ANC contacts.

Conclusion: Our study identified that the number of ANC contacts among pregnant mothers aged 15-49 years was associated with individual, household, and community-level factors. As the pooled weighted prevalence of the WHO-recommended higher ANC contacts was lower among the mothers, governments with international, local policymakers should focus on improving women’s and their partners' educational attainments, media coverage, community awareness about healthcare, and especially designing programs for rural mothers, women’s empowerment, and household socioeconomic status to increase uptake of ANC contacts. 

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