Knowledge, Attitudes, and Practices Regarding Antenatal Care among Women in High-Risk Areas of El Salvador: A Baseline Survey for Future Program Evaluation

Background: Despite substantial improvements in maternal health indicators and near-universal institutional delivery coverage in El Salvador, limited evidence is available regarding maternal health literacy and health-seeking behaviors among women residing in socioeconomically vulnerable and geographically isolated communities. This study aimed to establish baseline evidence on knowledge, attitudes, and practices related to antenatal care and maternal health among women living in high-risk municipalities of El Salvador.Methods: A cross-sectional baseline survey was conducted between June 2 and June 26, 2025, among 304 pregnant and postpartum women receiving care from five family community health units (UCSFs) located in high-risk municipalities of El Salvador. Data were collected using a structured 75-item questionnaire administered through KoBoToolbox. Descriptive statistics, Mann-Whitney U-tests, Pearson’s chi-square tests, and Spearman correlation analyses were performed.Results: Although antenatal care utilization was high (96.4%) and institutional delivery was nearly universal among multiparous women (97.5%), substantial gaps in technical maternal health knowledge were identified. Only 25.0% of participants demonstrated adequate knowledge regarding essential prenatal tests, and only 18.1% correctly identified the benefits of both iron and folic acid supplementation. Educational attainment was significantly associated with knowledge of prenatal tests and contraception (both P<0.001), whereas age was not associated with any knowledge indicator. Significant knowledge–practice gaps were observed, particularly regarding contraception (χ2=14.6, P=0.002) and tetanus vaccination (P=0.847), suggesting the presence of structural barriers beyond individual awareness. Territorial disparities of up to 25 percentage points were observed across participating facilities.Conclusions: High coverage of antenatal care services does not necessarily translate into adequate maternal health knowledge or optimal preventive practices. The findings identify priority areas for maternal health education and service-delivery strengthening and provide important baseline evidence for future monitoring and evaluation of maternal health interventions in vulnerable communities of El Salvador.