Variations in provision and uptake of antenatal care.

Antenatal care providers vary from one country to another. In Europe, most of the care is provided by obstetricians in some countries, while the role of midwives is important in other countries. Many women are attended by general practitioners in Canada and, to a lesser extent, in the US. Involvement of traditional birth attendants in antenatal care in more than 5% of the pregnancies has been reported in Guatemala, Honduras and Mexico only. Several indicators may be used to measure the utilization of antenatal care: the percentage of women receiving care, timing of the first visit, proportion of women receiving late or no care, number of visits and indexes of adequacy of antenatal care. Recent world data are provided. The percentage of women receiving antenatal care is higher than 90% in many countries, including some developing countries. However, the proportion of women with late or no care is increasing in the US. Women of low sociodemographic status are at high risk of having inadequate care. Financial barriers play a major role. Inadequate system capacity, distance, long waiting time, lack of child care and differences in culture, attitude and knowledge are other important barriers. Improving the services and outreach of non-participating women may both increase the utilization of antenatal care. Overutilization should also be a matter of concern. It could be better addressed by decreasing the recommended number of visits than by requesting payment of a part of the costs by the users.