|03. What Is the Evidence for the Role of Antenatal Care Strategies in the Reduction of Maternal Mortality and Morbidity?|
Antenatal care is practised all over the world, the programmes having essentially similar schedules and content. Adherence to those programmes vary greatly, however, both regarding attendance rates and the time of the first visit, most of the African countries having the poorest records. Little has been done to evaluate antenatal care; its contribution to safer childbirth rests on educated assumptions, not on scientific testing. Some randomised trials have shown no ill-effects of programmes with fewer visits. A large WHO-initiated trial of a new programme with only 4 visits for low-risk pregnant women and interventions scientifically shown to be beneficial has just been completed. Compared to a standard model of antenatal care the new package was equivalent to traditional care in all the pre-selected maternal and child outcomes, besides being cheaper.
By studying preventable factors for each major cause of maternal death, experts have estimated that maternal deaths can be reduced by at least 50%. The relative contribution of antenatal care is difficult to assess. Immunization programmes, iron prophylaxis, early detection of preeclampsia, education, advice and preparation for transport and safe delivery are elements which may make a difference. Inadequate reporting of maternal deaths and causes of death is an obstacle to proper monitoring of the epidemic of maternal death. Revision and upgrading of the systems should go hand in hand with quality improvement of antenatal care programmes.