A Review of Trends in Prenatal Care for Global Health

Stephanie Aiddoo, Parwinder Kaur, Nouhayla Essadsi, Osbourn Park High School, Manassas, Virginia, USA

Abstract

Accessibility to prenatal care (PNC) is determined by access to transportation,

location of healthcare facilities, health literacy levels, the safety of a mother’s

environment, and affordability of PNC. When PNC is not attainable, adverse outcomes

in pregnancy are more likely to occur. Women from disadvantaged backgrounds are

more likely to face adverse health outcomes because of the challenges they face in

their lives. Approximately 275,000 women died in 2017 due to pregnancy complications

and childbirth in low-resource settings (World Health Organization [WHO], 2019). To

combat this issue, governments can issue policies that expand access to medical

insurance, create programs that increase health literacy, provide affordable and

accessible screenings for at-risk patients, and provide paid leave to patients. With the

implementation of these interventions, PNC will be more readily available and utilized

on a global scale.

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Introduction

Disparities in access to health services are prevalent across the globe. According to the World Health Organization (WHO), about 275,000 women in 2017 died due to pregnancy complications and childbirth in low-resource settings. That year, low-income countries accounted for 94% of maternal deaths (Mweemba et al., 2021). Some causes of death include preventable complications: hemorrhage, hypertension, and infections. The risk of a woman in a low-income country dying from a maternal-related cause is 130 times higher compared to a woman living in a high-income country. This review will evaluate the social determinants of health (SDH) and clinical outcomes in global health for prenatal care (PNC).

Health Outcomes

The key to lowering maternal mortality is to keep an eye on racial/ethnic, socioeconomic, and rural-urban differences (Singh, 2020). The prevalence of sudden maternal mortality (SMM) varies greatly by ethnicity but rises uniformly at comparable rates. This study shows that medically complex circumstances cannot explain the presence of discrepancies in SMM. Comorbidities are defined as multiple illnesses that occur in one patient. Although the existence of these traits may hinder mother care, they are insufficient to fully explain the causes of SMM disparities. This is a significant discovery because it confirms the need to consider social and economic concerns in addition to clinical ones. PNC services have decreased the preterm birth (PTB) gap in Argentina and Ecuador, by approximately 57% and 30%, respectively. PTB is an adverse birth outcome that can lead to an increased risk of infant mortality and neurodevelopmental complications in childhood. Enhancing access to PNC may help these nations' ethnic differences in PTB risk decline (Wehby et al., 2016).

The Influence of SDH

As defined by WHO, the social determinants of health (SDH) are non-medical factors that impact health outcomes. Health literacy, working and living conditions, environmental factors, and health statistics are all factors that can positively or negatively affect health equity (Figure 1). These subcategories can be responsible for disparities in the utilization and accessibility of antenatal care (ANC) services.

Figure 1: Indicators for monitoring quality care (Saturno-Hernández et al., 2019).

In rural areas, health literacy regarding ANC is relatively low. ANC is a public health service with the purpose of preventing health risks to ensure the health of the woman and fetus (Manyeh et al., 2020). Addis Ababa, a large Ethiopian city, has higher literacy rates than rural southern Ethiopia, because of its levels of accessibility to healthcare information. As such, urban Ethiopian women are twice more likely to receive adequate PNC than rural Ethiopians (Tadele & Teka, 2021).

The location of healthcare facilities makes PNC inaccessible for some, such as the cattle camps of Ethiopia, South Sudan, and Mali—communities that require constant movement. Pregnant nomadic women find difficulty in traveling the long distances required to obtain PNC as there is often no reliable transportation (Dahab & Sakellariou, 2020). Inhabitants of rural communities must travel long distances to obtain healthcare services and may not be guaranteed provider availability. In the United States, the number of hospitals that provide obstetric services has declined in rural areas. As a result, pregnant women in rural areas in the U.S. are more likely to have pregnancy-related morbidity and mortality than urban women (Pan et al., 2021).

A woman’s environment may act as a hindrance in pursuing PNC. Traveling to health facilities in conflict areas, like South Sudan, is a challenge. Their lives are put in danger as they face the risk of getting killed, abducted, or targeted when traveling (Dahab & Sakellariou, 2020). Some women also fear violence in their own homes. During the Covid-19 pandemic, a global surge in domestic violence rates was observed (Ruyak & Kivlighan, 2021). Victims of domestic abuse may not have access to finances, transportation, or important documents (Ruyak & Kivlighan, 2021). The lack of access to resources ultimately prevents them from acquiring ANC.

Preventing Disparities in Maternal Mortality

Figure 2. Equity in ANC Quality: An Analysis of 91 National Household Surveys (Arsenault et al., 2017).

Preventative interventions can ensure that the issue of accessibility is resolved. Lawmakers should create policies that ensure the attainability of health insurance, affordable screenings for at-risk patients, and health literacy education programs. Other programs designed for minority women include Cognitive Behavior Therapy which is an intervention for a variety of mental health conditions such as depression and anxiety and group PNC programs (​​Gennaro, et al., 2017). In a study done in Nigeria, it was revealed that two-fifths of the facilities were inadequate in their knowledge of nutritional education for prenatal women (Ibikunle et al., 2021). Interventions that provide nutritional education to providers are essential. Importantly, the affordability of care correlates with the number of women who are willing to obtain PNC. This insinuates that health insurance and discount programs play an important role in PNC. Such discount programs that have been effective in reducing barriers to access prenantal care include the United States’ Medicaid France’s Universal Healthcare System.

Conclusion

This review assessed the SDH and indicators of quality prenatal care. Pregnant women in rural communities are less likely to attend prenatal care visits than urban women and, thus, more likely to experience complications. Government assistance is necessary to implement discount programs, educational content, and more accessible medical insurance. Further research is needed on the efficacy of preventative programs, such as evaluating increases in the health literacy of rural, less-educated populations after implementing educational programs.

Acknowledgments

This work was conducted under the Health Services Mentorship Program hosted under George Mason University's Academy Health Student Chapter alongside Jonathan Sanchez and Fatima Rafie.

References