Measuring antenatal care timing and content across 131 low-income and middle-income countries, 1995–2023: a systematic analysis of trends

BACKGROUND: Timely and comprehensive antenatal care can improve maternal and perinatal health by enabling early detection and treatment of pregnancy complications. We estimated the content and timing of antenatal care visits for 131 low-income and middle-income countries (LMICs) from 1995 to 2023. METHODS: We systematically identified population-representative data sources capturing antenatal care timing and content. We selected five widely measured indicators of antenatal care screening and prevention services: iron supplementation, measurement of weight and blood pressure, and provision of blood and urine samples. We modelled the proportion of women with a livebirth reporting all five items (antenatal care content proportion), mean number of items reported (antenatal care content mean), proportion with first trimester antenatal care attendance, and mean number of antenatal care visits using spatiotemporal Gaussian process regression. FINDINGS: Across LMICs, the proportion of women with a livebirth who initiated antenatal care in the first trimester increased from 46·2% (95% uncertainty interval 42·2-49·9) in 1995 to 63·7% (62·8-64·5) in 2023, and the average number of antenatal care visits during pregnancy rose from 3·7 (3·4-4·0) to 6·0 (5·9-6·1). In 2023, 69·3% (68·4-70·1) of women with a livebirth received all five antenatal care items, a major increase from 1995 (25·9% [24·1-27·8]). In 2023, the proportion of women who attended antenatal care but did not receive all five items (26·2% [25·5-27·0]) exceeded those who did not attend antenatal care at all (7·1% [6·5-8·1]). The receipt of all five items also varied by geography: 79·2% (77·6-80·5) in Latin America and the Caribbean received all five items, compared with 59·8% (58·4-60·9) of women in sub-Saharan Africa. INTERPRETATION: Despite improvements in the receipt of basic elements of antenatal care from 1995 to 2023, health systems continue to miss opportunities to deliver important care to women who attend antenatal care. The identified gaps in coverage should be targeted for improvement to support receipt of timely and effective health care that improves maternal and neonatal health. FUNDING: The Gates Foundation.