Changes in Access to and Use of Prenatal and Delivery Services

Young women who are giving birth to their first child face special risks because the probability of poor outcomes is higher for first births. Furthermore younger mothers face special risks at delivery, because they are likely to be less well educated, come from a rural area, live in a poorer household, and be less well nourished. Very young parenthood also carries heightened risks for physiological reasons. Adequate monitoring and care during pregnancy and at delivery can compensate to some extent for these factors, reducing the probability of poor outcomes (World Health Organization, 1992). Over the past decades, due in large part to concerted efforts by international agencies and country governments, awareness of the benefits of antenatal care, medical attendance at delivery (and in particular emergency obstetric care), and postpartum care have greatly increased and programmatic action has to some extent also improved (Family Care International, 1997).

Survey data show that the proportion of women who make at least one prenatal care visit is moderately high: the World Health Organization (WHO) estimates (circa 1996) that 65 percent of pregnant women obtain some prenatal care in the developing world on average (World Health Organization, 1997). Although these estimates are for women of all ages, they probably reflect the situation of adolescent mothers, given that DHS data show little variation by age in the use of antenatal care or attendance at delivery. There is some regional variation in access to antenatal care: the proportion obtaining some care is much higher, for example, in Eastern Asia (80 percent, including China) and Latin America and the Caribbean (73 percent), but is lower (50-60 percent) in South-central Asia and in Western, Middle, and Northern Africa. Nevertheless, in some of the poorest countries, this proportion is even lower (e.g., 29 percent in Ethiopia and 37 percent in Chad for adolescent women, based on DHS surveys). A limitation of this statistic is that, although it is an indicator of pregnant women obtaining some basic care during pregnancy, it does not suggest whether the care started early in pregnancy or whether the frequency of visits was sufficient to match women’s level of risk (World Health Organization, 1997).

The proportion who are attended at delivery by a trained medical professional (nurse, midwife, or doctor) is somewhat lower: 40 percent deliver in a health facility, but 53 percent are attended by a skilled professional (the difference is those who deliver at home but have a medical professional present). In some regions, the gap between antenatal care and attendance at delivery is much greater: for example, in Eastern, Middle, and Western Africa and in South-central Asia, an estimated 34-42 percent are attended by a medical professional at delivery. Estimates of the trend in the

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