Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa.
OBJECTIVE
We assess how countries in regions of the world where maternal mortality is highest-South Asia and Sub-Saharan Africa-are performing with regards to providing women with vital elements of the continuum of care.


METHODS
Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care-at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 h since birth. Family planning counseling within a year of birth was also included in the descriptive analyses.


RESULTS
Results indicated that a major drop-out (>50 %) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (<5 %) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements.


CONCLUSIONS
Understanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health.
MEASURE Evaluation/Carolina Population Center, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27516, USA. kavita_singh@unc.edu.|Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kavita_singh@unc.edu.
Kavita
K
Singh
MEASURE Evaluation/Carolina Population Center, University of North Carolina at Chapel Hill, CB# 7445, Chapel Hill, NC, 27516, USA.
William T
WT
Story
Global Health Fellows Program II, United States Agency for International Development (USAID), Washington, DC, USA.
Allisyn C
AC
Moran
D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D001208:Asia; D003266:Continuity of Patient Care / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D000068097:Maternal Health; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011203:Poverty; D011295:Prenatal Care / Q000379:methods / Q000458:organization & administration; D012111:Residence Characteristics; D055815:Young Adult
Antenatal care; Continuum of care; Family planning; Maternal health; PNC; Skilled delivery; South Asia; Sub-Saharan Africa