Impact of effective coverage of antenatal care on neonatal mortality in India

This paper examines the impact of antenatal care (ANC) on neonatal mortality using nationally representative data from India. For the first time, we apply the WHO Framework of effective coverage to measure health systems performance of ANC. We define effective coverage by creating an “Ideal” package of ANC consisting of 10 key interventions, and also define “Less Than Ideal” packages comprising different combinations of less than the 10 interventions. Using data from over 60,000 mother-child dyads from 1998/9 and 2005/6 National Family Health Surveys of India, we use multivariable logistic regression models to examine the association of ANC on neonatal mortality.

We find that only 10.4% of Indian women received effective ANC. There is substantial socioeconomic variation, with a 10-fold difference in effective coverage between the richest and poorest wealth quintile. Effective coverage is significantly associated with a 51% reduction in the odds of neonatal mortality (OR: 0.49; 95% CI: 0.36-0.67). This “Ideal package is more protective against neonatal mortality than other “Less Than Ideal” packages.

India’s health system is not meeting the needs of pregnant women. Improving utilisation and delivery of the components of ANC to improve service quality, has important consequences for improving child health in India.