Timely Initiation of New Antenatal care Contact model and its associated factors among pregnant women at Munessa Health facilities, Ethiopia; A facility based cross-sectional study – Frontiers

Report on Timely Antenatal Care Initiation in Ethiopia and its Alignment with Sustainable Development Goals

Executive Summary

This report analyzes the findings of a cross-sectional study conducted in Munessa, Ethiopia, to assess the timely initiation of Antenatal Care (ANC) among pregnant women. The study reveals a critically low rate of timely ANC initiation, which poses a significant challenge to the achievement of key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being). With only 26.5% of women beginning ANC within the recommended first trimester, and with low levels of knowledge and positive attitudes toward the new ANC model, urgent interventions are required. This report contextualizes these findings within the framework of the SDGs, highlighting the interconnectedness of health (SDG 3), education (SDG 4), and gender equality (SDG 5) in improving maternal and child health outcomes.

Introduction: Aligning Antenatal Care with Sustainable Development Goals

The global health agenda, as outlined in the Sustainable Development Goals, places a strong emphasis on improving maternal and child health. The new World Health Organization ANC model, which recommends initiation within the first 12 weeks of gestation, is a primary strategy for achieving these goals.

The Role of ANC in Achieving SDG 3

Timely initiation of ANC is fundamental to realizing several targets within SDG 3:

• Target 3.1: Reduce the global maternal mortality ratio. Early ANC allows for the identification and management of pre-existing conditions and pregnancy-related complications, directly contributing to the reduction of maternal deaths.
• Target 3.2: End preventable deaths of newborns and children under five. Quality ANC improves fetal and neonatal health outcomes through screening, preventive measures, and health promotion.
• Target 3.7: Ensure universal access to sexual and reproductive health-care services. ANC is a critical component of the continuum of reproductive healthcare.

This study evaluates the status of timely ANC initiation in Ethiopia, providing crucial data on the progress and barriers toward meeting these global targets.

Methodology

The research employed a quantitative, facility-based approach to gather data on ANC practices.

• Study Design: A cross-sectional study was conducted.
• Study Period: Data was collected between April and May 2024.
• Participants: A total of 482 pregnant women attending Munessa Health facilities were included.
• Sampling Technique: A systematic sampling method was used to select participants.
• Data Collection: An interviewer-administered questionnaire was utilized.
• Data Analysis: Epidata and SPSS were used for data entry and analysis, with binary and multivariable logistic regressions identifying significant determinants.

Key Findings and Implications for SDGs

The study’s findings reveal significant gaps in ANC uptake and knowledge, directly impacting the potential to achieve related SDG targets.

Status of Timely ANC Initiation: A Challenge to SDG 3

Only 127 participants (26.5%) initiated ANC within the recommended first trimester. This low rate represents a major obstacle to achieving the maternal and neonatal mortality reduction targets outlined in SDG 3. It indicates a failure in the health system to ensure women receive essential care at the most critical stage of pregnancy.

Knowledge and Attitude Levels: Barriers to Health Literacy (SDG 4)

The study identified significant deficits in health education, a key component of SDG 4 (Quality Education).

• Knowledge: Only 83 women (17.3%) demonstrated good knowledge of the new ANC contact model.
• Attitude: While 215 women (44.8%) held a positive attitude, a majority still lacked the positive disposition necessary to drive proactive health-seeking behavior.

These findings underscore the need to integrate comprehensive health education into formal and informal learning platforms to empower women with the knowledge required for their well-being.

Determinants of Timely ANC Initiation

Several factors were significantly associated with the timely initiation of ANC, each with implications for SDG-focused interventions.

1. Education: Attending non-formal learning was associated with lower odds of timely initiation, pointing to a need for targeted educational outreach that aligns with SDG 4 to ensure all women, regardless of educational background, receive vital health information.
2. Pregnancy Awareness: Women who confirmed their pregnancy with a urine test were 6.4 times more likely to initiate ANC on time. This highlights the importance of promoting early pregnancy detection as a gateway to timely care, supporting SDG 3.
3. Obstetric History: Having no prior history of abortion or ANC complications was associated with delayed initiation. This suggests that health messaging must be universal and not only targeted at high-risk groups, promoting equity in health access as envisioned in SDG 10 (Reduced Inequalities).

Conclusion and Recommendations for SDG Achievement

The study concludes that substantial and concerted efforts are required to improve the timely initiation of ANC in Ethiopia. To accelerate progress toward the SDGs, a multi-faceted approach is essential.

Strengthening Health Systems for SDG 3

• Enhance community outreach programs to promote the benefits of early ANC.
• Ensure health facilities are equipped and staffed to provide high-quality, welcoming ANC services from the first trimester.

Enhancing Education and Awareness for SDG 4

• Launch public health campaigns to raise awareness about the new ANC model and the importance of the first contact within 12 weeks.
• Develop and distribute educational materials on pregnancy danger signs and the benefits of early medical consultation.

Promoting Gender Equality and Empowerment for SDG 5

• Implement programs that empower women with the autonomy and knowledge to make informed decisions about their reproductive health.
• Engage male partners and community leaders to foster a supportive environment that encourages and facilitates timely ANC attendance for all pregnant women.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

   • SDG 3: Good Health and Well-being: The article’s central theme is antenatal care (ANC), a critical component of maternal and child health. The study’s objective to “evaluate the extent of timely initiation” of ANC and its goal to “improve the health of expectant mothers and unborn children” directly align with ensuring healthy lives and promoting well-being for all at all ages.
   • SDG 5: Gender Equality: The article focuses exclusively on the health of pregnant women. Ensuring women have access to essential healthcare services like ANC, as well as the knowledge and positive attitude to utilize them, is fundamental to achieving gender equality and empowering women to take control of their reproductive health. The study highlights disparities in knowledge and access that affect women specifically.

2. What specific targets under those SDGs can be identified based on the article’s content?

   • Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births. The article supports this target by focusing on timely ANC initiation, which is a key strategy for the “early identification and treatment of preexisting and pregnancy-related conditions” and avoiding “ANC complications,” thereby reducing the risk of maternal death.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. The study directly measures the coverage of a quality essential health service by reporting that only “127 (26.5%) of the women initiated ANC on time,” indicating a significant gap in achieving universal health coverage for this service in the studied population.
   • Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences. Antenatal care is a fundamental component of sexual and reproductive healthcare. The article’s conclusion, which calls for “raising mothers’ attitudes and level of awareness about ANC services,” directly addresses the need for better information and access to these services.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

   • Indicator 3.8.1 (Coverage of essential health services): The article provides a precise quantitative measure for this indicator. The finding that “127 (26.5%) of the women initiated ANC on time” is a direct measurement of the coverage of timely antenatal care, which is an essential health service.
   • Implied Indicator for Target 3.1 (Proportion of women receiving timely and quality ANC): While the official indicator is the maternal mortality ratio (3.1.1), the article’s data on timely ANC initiation serves as a crucial process indicator. Low timely initiation (26.5%) suggests a higher risk of negative maternal health outcomes, which this target aims to prevent. The study’s mention of “no history of ANC complications” as a factor also relates to the quality and effectiveness of care.
   • Implied Indicator for Target 5.6 (Proportion of women with knowledge of reproductive health services): The article measures knowledge and attitude as precursors to accessing care. The statistic that only “83 (17.3%) pregnant women had… good knowledge of the new ANC contact model” serves as a proxy indicator for measuring women’s awareness and ability to make informed decisions about their reproductive health, which is a core component of Target 5.6.

SDGs, Targets, and Indicators Table

Source: frontiersin.org