Arsenault C, et al. - Experts systematically evaluated the inequalities in health-care quality. Much lower and inequitable levels of quality were seen in many low-income and middle-income countries (LMICs) that have reached high levels of antenatal care coverage. Greater focus on the quality of health services and their equitable distribution was required for achieving ambitious maternal, newborn, and child health goals. Findings suggested the utility of equity in effective coverage as the new metric to monitor progress towards universal health coverage.

Methods

• Among women who had at least one visit with a skilled antenatal-care provider, authors described antenatal care quality based on receipt of three essential services (blood pressure monitoring and urine and blood testing) using the most recent (2007–2016) Demographic and Health Surveys and Multiple Indicator Cluster Surveys in 91 LMICs.
• They compared quality across country income groups and quantified within-country wealth-related inequalities using the slope and relative indices of inequality.
• They summarized inequalities using random-effects meta-analyses and evaluated the extent to which other geographical and sociodemographic factors could explain these inequalities.

Results

• Globally, blood pressure monitoring and urine and blood testing were reported by 72.9% (95% CI 69,1–76,8) of women who used antenatal care; this number ranged from 6.3% in Burundi to 100.0% in Belarus.
• In low-income countries, antenatal care quality lagged behind antenatal care coverage, where 86.6% (83.4–89.7) of women accessed care but only 53,8% (44.3-63.3) reported receiving the three services.
• They noted an association of receipt of the three services with gross domestic product per capita and it was 40 percentage points higher in upper-middle-income countries vs low-income countries.
• Within countries, compared to the poorest, the wealthiest women were on average four times more likely to report good quality care (relative index of inequality 4.01, 95% CI 3.90–4.13).
• They noted substantial inequality even after adjustment for subnational region, urban residence, maternal age, education, and number of antenatal care visits (3.20, 3.11-3.30).