Dr. Lale Say
Medical Officer for Monitoring and Evaluation
Department of Reproductive Health and Research
World Health Organization
Postal Address:20 avenue Appia, Geneva, Switzerland
Telephone: +41 22 791 4816
Fax: +41 22 791 4171
Statistics and Monitoring Section
Division of Policy and Planning
United Nations Children’s Fund
Telephone: +1 212-303-7932
Fax: +1 212-735-4411
Three United Nations Plaza
New York, NY 10017
Antenatal care coverage (at least one visit) is the percentage of women aged 15-49 with a live birth in a given time period that received antenatal care provided by a skilled health personnel (doctors, nurses, or midwives) at least once during pregnancy, as a percentage of women age 15-49 years with a live birth in a given time period.
Antenatal care coverage (at least four visits) is the percentage of women aged 15-49 with a live birth in a given time period that received antenatal care four or more times as a percentage of women age 15-49 years with a live birth in a given time period. Available survey data on this indicator usually do not specify the type of the provider, therefore, in general, receipt of care by ANY provider is measured.
Skilled health personnel refers to workers/attendants which are accredited health professionals - such as a midwife, doctor or nurse - who have been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns. Both trained and untrained traditional birth attendants (TBA) are excluded.
The antenatal period presents opportunities for reaching pregnant women with interventions that may be vital to their health and wellbeing and that of their infants. WHO recommends a minimum of four antenatal visits based on a review of the effectiveness of different models of antenatal care. WHO guidelines are specific on the content of antenatal care visits, which should include:
Antenatal coverage, at least one visit: The number of women aged 15-49 with a live birth in a given time period that received antenatal care provided by skilled health personnel (doctors, nurses or midwives) at least once during pregnancy, is expressed as a percentage of women aged 15-49 with a live birth in the same period.
Antenatal coverage, at least four visits: The number of women aged 15-49 with a live birth in a given time period that received antenatal care by ANY provider (whether skilled or unskilled) four or more times during pregnancy, is expressed as a percentage of women aged 15-49 with a live birth in the same period.
Receiving antenatal care during pregnancy does not guarantee the receipt of interventions that are effective in improving maternal health. Receiving antenatal care at least four times, which is recommended by WHO, increases the likelihood of receiving effective maternal health interventions during antenatal visits. Importantly, although the indicator for “at least one visit” refers to visits with skilled health providers (doctor, nurse, midwife), “four or more visits” refers to visits with ANY provider because national-level household surveys do not collect provider data for each visit. In addition, standardization of the definition of skilled health personnel is sometimes difficult because of differences in training of health personnel in different countries.
Discrepancies are possible if there are national figures compiled at the health facility level. These would differ from the global figures that are typically based on survey data collected at the household level.
In terms of survey data, some survey reports may present a total percentage of pregnant women with ANC from a skilled health professional that does not conform to the Millennium Development Goals (MDG) definition (for example, includes a provider that is not considered skilled such as a community health worker). In that case, the percentages with ANC from a doctor, a nurse or a midwife are totaled and entered into the global database as the MDG estimate.
UNICEF and WHO maintain antenatal care data (for at least one visit and at least four visits) and both collaborate to ensure the consistency of data sources. National-level household surveys are the main data sources used to collect data for the antenatal care indicators. These surveys include Demographic and Health Surveys (DHS), Multiple Indicator Cluster Surveys (MICS), Reproductive Health Surveys (RHS) and national surveys based on similar methodologies. The surveys are undertaken every 3 to 5 years. For mainly industrialized countries (where the coverage is high), data sources include routine service statistics.
Before acceptance into the global databases, UNICEF and WHO undergo a verification process that includes correspondence with field offices to clarify any questions regarding estimates. During this process, the national categories of skilled health personnel are verified, and so the estimates for some countries may include additional categories of trained personnel beyond doctors, nurses, and midwives.
There is no treatment of missing values. When the information needed to calculate the indicator is not available, the indicator is not estimated.
Data for at least one visit are available for over 150 countries. Data for at least four visits are available for nearly 100 countries, and are only captured for developing countries.
National household surveys such as DHS, MICS and RHS are generally conducted every three to five years. Survey data on key child and maternal health indicators are published annually by UNICEF in the State of the World’s Children Report within one-two years of fieldwork and are available on www.childinfo.org.
Regional and global estimates are based on population-weighted averages weighted by the total number of births. These estimates are presented only if available data cover at least 50% of total births in the regional or global groupings.
Estimates are published annually, in May by WHO in World Health Statistics http://http://www.who.int/whosis/whostat/en/ and in December, by UNICEF in State of the World’s Children, and are available at