Traditionally antenatal care (ANC) has been measured as coverage indicator in RMNCAH+N programs, such as the number of women who received any ANC or received 4+ ANC visits. However, from Demographic Health Survey and other data sources it is clear that critical gaps in antenatal care quality often occur . Member of Countdown's equity data & analysis center recently published two papers using a proposed indicator called ANCq that takes into account ANC quality.

The first paper, published in the Journal of Global Health, describes how the ANCq was created and validated using national survey data from 63 low and middle income countries during 2000-2017, using data based upon contact with the health services and content of care received. It is calculated as a score to give an idea of level of adequacy and to consider all pregnant women in need of ANC. The ANCq presented good validity properties, being a useful tool for assessing ANC coverage and adequacy of care. The study results showed that the ANCq was inversely associated with neonatal mortality, suggesting that the indicator is capturing relevant aspects of ANC.

The second paper, published in the International Journal for Equity in Health, used the ANCq content-qualified coverage indicator to explore the socioeconomic inequalities in ANC, using the same set of DHS and MICS data from 63 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 a wide range of inequality, with some managing to achieve very low inequality. These findings again highlighted the need to use equity analysis to help countries achieve the Sustainable Development Goals.

This analysis stream also relates to the analysis being undertaken by Countdown's effective coverage data & analysis center, which was presented in a recent webinar.