Enhancing birth weight outcomes through improved antenatal care in West African countries: Evidence from propensity score matching analysis

While many underlying causes of low birth weight (LBW, < 2500 grams) are preventable through overall antenatal care (ANC) uptake, limited empirical evidence exists in West Africa quantifying the impact of the WHO-recommended four or more visits (ANC4+) and eight or more visits (ANC8+) models using rigorous causal inference techniques. Thus, this study aimed to examine the causal effect of those two models on birth weight outcomes in West African countries using propensity score matching (PSM). This study included a weighted sample of 51,455 women sourced from Demographic and Health Surveys (DHS) data from 14 West African countries (2012-2023). Covariates associated with treatments (ANC4+ and ANC8+) and birth weight were identified using Chi-square tests, one-way analysis of variance (ANOVA), and t-tests, and those deemed confounders were included in PSM. PSM was applied using a logit model to estimate the causal effects of ANC4+ and ANC8+ on birthweight. Average Treatment Effect on the Treated (ATT) and Average Treatment Effect (ATE) were calculated for each exposure. Quality of matching was assessed both statistically and graphically. Sensitivity analysis was done using Rosenbaum bounds to estimate unmeasured confounding and confirm the robustness of treatment effects. The mean birthweight was 3121.2 grams (±669.0), with 10.42% of newborns classified as LBW. Receiving ANC8+ and ANC4 + were associated with a birthweight increase of 102.36 and 83.89 grams, respectively. Across the entire population, ANC8+ and ANC4 + were linked to average birthweight increases of 89.09 and 75.81 grams, respectively. Of the weighted sample, 71.38% and 14.54% of women received ANC4+ and ANC8 + , respectively. All matching diagnostics demonstrated strong covariate balance and confirmed the validity of the treatment effect estimates. The treatment and control groups were well comparable for the baseline confounders after matching (p-value > 0.05). This study found that receiving ANC4+ or ANC8 + has a positive effect on birth weight, underscoring the importance of scaling up efforts to ensure comprehensive ANC coverage, especially ANC8 + , in the region to reduce LBW prevalence and improve neonatal survival.