Strengthening the first antenatal visit to improve maternal health: results from a cross-sectional study in Bantul, Indonesia

Antenatal care (ANC) is an evidence-based intervention aimed to improve mothers' and newborns' health, but its effectiveness depends on service quality at each visit. This study aims to assess the quality of integrated ANC and associated factors in public health centers (PHCs) in Bantul, Indonesia. A facility-based cross-sectional study was conducted from February to April 2024. A total of 444 study participants out of 17 PHCs were selected using a cluster random sampling technique. We collected data on service quality structures, processes, and output. We analyzed visit time, visit initiation, waiting time, consultation duration, and satisfaction with the quality of integrated ANC. Data were collected through observation and interviews with pre-tested structured questionnaires. Bivariate and multivariable logistic regressions were used to analyze the relationship between the outcome and predictor factors. A total of 293 (66%) of pregnant women received a good integrated ANC. The majority of respondents were between the ages of 20-35 (86.71%), had a low level of education (67.34%), and had insurance (88.74%). Based on input variable observations, five PHCs (29.41%) did not offer psychological services due to a lack of psychologists. ANC visits (aOR 2.57; 95% CI 1.67-3.95), insurance ownership (aOR 2.47; 95% CI 1.31-4,68), and education (aOR 0.50; 95% CI 0.31-0.80) were significant predictors of ANC quality. Two-thirds of pregnant women received high-quality integrated ANC in Bantul. The initial visit is a good predictor of ANC quality. Educational promotion, partnerships with local leaders, PHC capacity building with appropriate resources, and insurance coverage are crucial for improving the initial ANC visit.