Good quality antenatal care (ANC) helps reduce adverse maternal and newborn outcomes, especially in low and middle-income countries (LMICs). Most of the currently used ANC indicators only measure contact with services.

We used data from national surveys conducted in LMICs to create and validate a new ANC indicator, applicable to all women in need of ANC measured as a score, considering ANC contact and content.

We selected ANC related variables from national health surveys to build a score. Variables were selected to make the indicator estimable for the largest number of surveys possible. We used Cronbach’s alpha and factor analysis to assess the proposed indicator. We also used a convergent validation approach exploring how the proposed indicator was associated with neonatal mortality.

The resulting indicator, named ANCq, was developed for 63 countries. It was derived from seven variables related to contact with services and content of care ranging from zero to ten. The overall mean of ANCq was 6.7, ranging from 3.5 in Afghanistan to 9.3 in Cuba and the Dominican Republic. In most countries, the ANCq was inversely associated with neonatal mortality and the pooled for all surveys Odds Ratio was 0.90 (95% CI = 0.88-0.92).

Our findings suggest that ANCq presented good validity properties, being a useful tool for assessing ANC coverage and adequacy of care in monitoring and accountability exercises.

Link to access the full text: http://www.jogh.org/documents/2021/jogh-11-04008.pdf