What is the efficacy/effectiveness of antenatal care?

Summary

The issue

Antenatal care, also known as prenatal care, is the complex of interventions that a pregnant woman receives from organized health care services. The number of different interventions in antenatal care is large. These interventions may be provided in approximately 12-16 antenatal care visits during a pregnancy. The purpose of antenatal care is to prevent or identify and treat conditions that may threaten the health of the fetus/newborn and/or the mother, and to help a woman approach pregnancy and birth as positive experiences. To a large extent antenatal care can contribute greatly to this purpose and can in particular help provide a good start for the newborn child.

Many questions have been posed about the health benefits of antenatal care, especially in relation to its costs. Given the limited resources of health care and the wide range of services provided as part of antenatal care, such questions must be dealt with. Care should be appropriate, cost-effective and based on the needs of the specific pregnant woman.

Findings

Observational studies have clearly demonstrated that antenatal care prevents health problems for both mother and child. Yet until fairly recently, little was known about which elements of antenatal care were particularly valuable. Research shows that many antenatal interventions are unnecessary or of unproven benefit. Nevertheless, components of antenatal care and timing continue to be introduced without scientific evaluation.

In general terms, antenatal care is relatively expensive. In a multicountry randomized trial carried out by the World Health Organization (WHO), the average cost was about US $3000 per pregnant woman in 1996. The main cost of antenatal care was found to be due to the interventions that follow from the suspected problems found during the process of care. Therefore, antenatal care needs to be scrutinized and planned carefully. WHO has developed and evaluated a simplified model of care and has demonstrated in a large study that it provides the benefits of more complicated models while tending to save money.

Policy considerations

1. Antenatal care is one of the most important services in health care. Every pregnant woman should have full access to it.
2. Excessive, unneeded and unproven interventions are often provided to women with normal pregnancies. A simplified model of care, as developed by WHO, based on evidence of benefit, seems quite appropriate.
3. Many antenatal interventions have never been evaluated, and there is a great need for more research.