Antenatal care (ANC) is an essential intervention associated with a reduction of maternal and new-born morbidity and mortality. However, evidence suggested substantial inequalities in maternal and child health, mainly in low- and middle-income countries (LMICs).

We conducted a global analysis of socioeconomic inequalities in ANC using national surveys from 63 LMICs. ANC was measured using the ANCq, a novel content-qualified ANC coverage indicator, created and validated using national surveys, based upon contact with the health services and content of care received.

We performed stratified analysis to explore the socioeconomic inequalities in ANCq. We also estimated the slope index of inequality, which measures the difference in coverage along the wealth spectrum.

The results showed large inequalities between and within countries. Higher ANCq scores were observed among women living in urban areas, with secondary or more level of education, belonging to wealthier families and with higher empowerment in nearly all countries. Countries with higher ANCq mean presented lower inequalities; while countries with average ANCq scores presented wide range of inequality, with some managing to achieve very low inequality.

Despite all efforts in ANC programs, important inequalities in coverage and quality of ANC services persist. Our findings suggest that interventions, that consider the social determinants of health and reduce socioeconomic inequalities in ANC are required in most LMICs. Also, those gaps that we documented must be bridged to achieve maternal and child mortality goals proposed in the 2030 SDG agenda.

This work was published in the International Journal for Equity in Health.

Link to access the full text: https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01440-3