title: Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries.
abstract: Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador.
  
  
  
  We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester.
  
  
  
  Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness.
  
  
  
  Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region.
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA. edanse@uw.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: Dansereau
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Claire R
authors.initials: CR
authors.lastname: McNellan
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Marielle C
authors.initials: MC
authors.lastname: Gagnier
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Sima S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Harvard School of Public Health, 677 Huntington Ave., Boston, MA, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Haakenstad
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Casey K
authors.initials: CK
authors.lastname: Johanns
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Palmisano
authors.affiliation: Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
authors.forename: Diego
authors.initials: D
authors.lastname: Ríos-Zertuche
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schaefer
authors.affiliation: Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
authors.forename: Paola
authors.initials: P
authors.lastname: Zúñiga-Brenes
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Hernandez
authors.affiliation: Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá.
authors.forename: Emma
authors.initials: E
authors.lastname: Iriarte
authors.affiliation: Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
mesh_terms: D000293:Adolescent; D000328:Adult; D002489:Central America; D005260:Female; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D016015:Logistic Models; D008800:Mexico; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000191:economics / Q000706:statistics & numerical data*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Antenatal care; Coverage; Household surveys; Prenatal care; Salud Mesoamérica Initiative; Skilled ANC