PLOS Global Public Health · 8 authors, 4 centres
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Using DHS data from six South Asian countries (n=146,284 children), this cross-national cohort study found that women receiving both high quantity (≥4 visits) and high quality (≥5 of 10 interventions) antenatal care had significantly lower odds of low birthweight in four of six countries compared to low quantity/low quality care. Neither frequent visits alone nor receipt of interventions alone was consistently sufficient to prevent low birthweight.
Women were classified into four groups based on ANC quantity (≥4 visits) and quality (≥5 of 10 interventions). LBW prevalence ranged from 11% in Nepal to 23% in Pakistan, with India accounting for two-thirds of the estimated 6.37 million regional LBW births annually. Fixed-effect logistic regression models, adjusted for individual, household, and state-level confounders, showed that high quantity/high quality ANC was associated with significantly lower odds of LBW in India (AOR 0.84), Nepal (0.57), Pakistan (0.45), and Sri Lanka (0.73) compared to low quantity/low quality care. In four of six countries, findings suggested that fewer high-quality visits may be more protective than many low-quality visits. Limitations include reliance on self-reported ANC service receipt, use of a 4-visit threshold rather than the updated WHO recommendation of 8 visits, and exclusion of ANC timing. The findings support prioritizing both ANC utilization and the delivery of recommended interventions.
