Prevalence and Determinants of Adequate Compliance with Antenatal Care in Peru

An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model.

Results

A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, havingsecondaryor higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC.

Conclusion

Only 3 out of 10women in Peru showed adequate compliancewith ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.

Keywords:
prenatal care; health surveys; cross-sectional studies; quality of health care; maternal health; maternal health services; Peru

Characteristics	Absolute frequency (n = 18,386)	Weighted proportion^* (95%CI)	Inadequate ANC (95%CI)	Adequate ANC (95%CI)	p-value^**
Age group (years)
15–19	921	4.8 (4.4–5.3)	73.7 (69.8–77.2)	26.3 (22.8–30.2)	< 0.001
20–34	12,090	65.0 (64.0–65.9)	63.7 (62.5–64.9)	36.3 (35.1–37.5)
35–49	5,375	30.2 (29.3–31.1)	66.6 (64.8–68.4)	33.4 (31.6–35.2)
Level of schooling
No education / Primary education	3,533	18.7 (17.9–19.5)	71.7 (69.6–73.7)	28.3 (26.3–30.4)	< 0.001
Secondary education	8,576	45.7 (44.6–46.7)	62.8 (61.3–64.2)	37.2 (35.8–38.7)
Higher education	6,277	35.6 (34.6–36.7)	64.4 (62.8–66.0)	35.6 (34.0–37.2)
Wealth quintile
Quintile 1 (lowest)	4,845	23.2 (22.3–24.1)	71.2 (69.4–73.0)	28.8 (27.0–30.6)	< 0.001
Quintile 2	5,062	24.7 (23.7–25.7)	62.7 (60.7–64.7)	37.3 (35.3–39.3)
Quintile 3	3,735	19.9 (19.1–20.7)	60.4 (58.3–62.5)	39.6 (37.5–41.7)
Quintile 4	2,787	17.5 (16.6–18.4)	62.7 (60.0–65.3)	37.3 (34.7–40.0)
Quintile 5 (highest)	1,957	14.8 (14.0–15.6)	68.3 (65.3–71.1)	31.7 (28.9–34.7)
Geographic region
Coast	7,908	56.2 (55.1–57.3)	63.0 (61.4–64.5)	37.0 (35.5–38.6)	< 0.001
Andean	5,988	26.9 (25.7–28.1)	74.9 (73.2–76.4)	25.1 (23.6–26.8)
Amazon	4,490	16.9 (16.0–17.9)	56.3 (54.1–58.4)	43.7 (41.6–45.9)
Residence area
Urban	13,230	74.8 (74.0–75.6)	63.3 (62.0–64.5)	36.7 (35.5–38.0)	< 0.001
Rural	5,156	25.2 (24.4–26.0)	70.3 (68.3–72.2)	29.7 (27.8–31.7)
Pulic health insurance
Not	5,191	32.8 (31.8–33.8)	68.1 (66.2–70.0)	31.9 (30.0–33.8)	< 0.001
Yes	13,195	67.2 (66.2–68.2)	63.5 (62.3–64.7)	36.5 (35.3–37.7)
Ethnicity
Non-native	16,808	93.7 (93.1–94.3)	64.2 (63.1–65.3)	35.8 (34.7–36.9)	<0.001
Native	1,578	6.3 (5.7–6.9)	77.0 (73.8–79.9)	23.0 (20.1–26.2)
Birth order
1	6,033	33.6 (32.7–34.4)	63.1 (61.4–64.8)	36.9 (35.2–38.6)	0.001
2 to 3	9,146	50.0 (49.1–50.9)	65.2 (63.8–66.5)	34.8 (33.5–36.2)
≥ 4	3,207	16.4 (15.8–17.1)	68.5 (66.3–70.6)	31.5 (29.4–33.7)
Desired pregnancy
Yes	8,470	46.2 (45.2–47.1)	61.2 (59.7–62.7)	38.8 (37.3–40.3)	< 0.001
No	9,916	53.8 (52.9–54.8)	68.3 (67.0–69.6)	31.7 (30.4–33.0)
Type of pregnancy
Multiple	168	0.9 (0.7–1.0)	63.9 (54.6–72.3)	36.1 (27.7–45.4)	0.801
Single	18,218	99.1 (99.0–99.3)	65.0 (64.0–66.1)	35.0 (33.9–36.0)

Characteristic	Absolute frequency (n = 18,386)	Weighted proportion* (95% confidence interval)
Care for by skilled health care personnel	18,042	98.3 (97.9–98.6)
Six antenatal care visits or more	16,499	89.7 (89.1–90.3)
First antenatal care visit within first trimester	14,768	81.1 (80.3–81.9)
Antenatal care with appropriate content	7,921	42.6 (41.5–43.7)
All four characteristics	6,526	35.0 (33.9–36.0)

Characteristic	Bivariate model		Adjusted model*
Characteristic	PR (95%CI)	p-value	aPR (95%CI)	p-value
Age group (years)
15–19	Ref.		Ref.
20–34	1.38 (1.20–1.59)	< 0.001	1.38 (1.19–1.60)	< 0.001
35–49	1.27 (1.09–1.47)	0.002	1.36 (1.16–1.61)	< 0.001
Level of schooling
No education / Primary education	Ref.		Ref.
Secondary education	1.31 (1.21–1.42)	< 0.001	1.19 (1.10–1.29)	< 0.001
Higher education	1.26 (1.15–1.37)	< 0.001	1.17 (1.06–1.30)	0.002
Wealth quintile
Quintile 1 (lowest)	Ref.		Ref.
Quintile 2	1.30 (1.19–1.41)	< 0.001	1.12 (1.02–1.23)	0.021
Quintile 3	1.38 (1.27–1.49)	< 0.001	1.18 (1.06–1.31)	0.002
Quintile 4	1.30 (1.18–1.43)	< 0.001	1.13 (1.00–1.28)	0.058
Quintile 5 (highest)	1.10 (0.99–1.23)	0.085	1.00 (0.87–1.16)	0.948
Geographic region
Coast	Ref.		Ref.
Andean	0.68 (0.63–0.73)	< 0.001	0.73 (0.67–0.79)	< 0.001
Amazon	1.18 (1.11–1.26)	< 0.001	1.26 (1.17–1.35)	< 0.001
Residence area
Urban	Ref.		Ref.
Rural	0.81 (0.75–0.87)	< 0.001	0.94 (0.85–1.03)	0.188
Public health insurance
No	Ref.		Ref.
Yes	1.14 (1.07–1.22)	< 0.001	1.25 (1.16–1.34)	< 0.001
Ethnicity
Non-native	Ref.		Ref.
Native	0.64 (0.56–0.74)	< 0.001	0.83 (0.71–0.96)	0.010
Birth order
1	Ref.		Ref.
2 to 3	0.94 (0.89–1.00)	0.052	0.92 (0.87–0.98)	0.006
≥ 4	0.85 (0.79–0.93)	<0.001	0.92 (0.84–1.01)	0.070
Desired pregnancy
Yes	Ref.		Ref.
No	0.82 (0.78–0.86)	<0.001	0.82 (0.78–0.86)	< 0.001
Type of pregnancy
Multiple	Ref.		Not included
Single	0.97 (0.76–1.24)	0.800

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[1] Address for correspondence Akram Hernández-Vásquez, Physician, Master in Management and Public Policy, Universidad San Ignacio de Loyola, 550, La Fontana Av, La Molina, Lima, 15024, Peru (e-mail: ahernandez@usil.edu.pe).