Factors influencing pregnant women's use of antenatal and emergency care services covered by social security: findings from the maternal eCohort in Mexico.

BACKGROUND

Evidence on antenatal care (ANC) and emergency service utilization during pregnancy in Latin America remains limited. Understanding these patterns is critical given the substantial benefits of ANC and emergency services in improving maternal and neonatal outcomes, preventing and managing pregnancy complications, and reducing maternal and infant mortality. This study examined ANC and emergency service utilization among pregnant women affiliated with the Mexican Institute of Social Security (IMSS) and identified factors associated with their use.

METHODS

We conducted an observational eCohort study through telephone interviews with 1,390 pregnant women aged 18-49 who initiated ANC at IMSS. Outcomes included the number of ANC visits, emergency room use, perceived quality of ANC, and provider competence assessed through 12 recommended ANC activities: blood pressure and weight measurement, blood and urine tests, ultrasound, and counseling on nutrition, warning signs, birth preparedness, newborn care, psychological health, and folic acid and iron supplementation. Multivariable negative binomial regression models were used to identify factors associated with ANC attendance and emergency service use.

RESULTS

Of the full cohort, 3.7% exited due to miscarriage, 12.4% dropped out after baseline, and 11.8% dropped out during follow-up. One-third of women who left rated the quality of their first ANC visit as poor or fair. In addition, 30% of women who remained in the cohort reported poor or fair ANC quality. On average, participants reported six ANC visits, with 64.8% receiving at least 80% of the 12 recommended ANC activities. Nearly 30% sought emergency services during pregnancy. Higher ANC attendance was associated with hypertension, urinary infections, anemia, early ANC initiation, consultations with obstetricians, and hospital-based ANC follow-ups. Use of emergency services was more common among women with chronic diseases, hypertensive disorders of pregnancy, urinary tract infections, risk of miscarriage, or risk of depression.

CONCLUSIONS

Substantial improvements in ANC are needed to strengthen women's care experiences and promote consistent utilization of ANC services.