Providing information on pregnancy complications during antenatal visits: Unmet educational needs in Sub-Saharan Africa

Background: Pregnancy complications threaten the survival and the health of many mothers and babies in Sub-Saharan Africa (SSA). While most women deliver at home, lack of awareness of the danger signs contributes to harmful delays in care-seeking when complications arise.

Objectives: We explored whether or not women receive advice on pregnancy complications during antenatal visits (ANV), and whether receiving advice influences the likelihood of institutional delivery.

Method: We performed a cross-country analysis on data from the most recent Demographic and Health Surveys of 19 Sub-Saharan African countries, focusing on women who received ANV during the pregnancy of their youngest child (N= 69, 073). From mother's reports we established whether a woman was told about pregnancy complication and whether she delivered in a health centre or at home. Multilevel logistic regressions predicted the likelihood of these events as a function of mother's age, parity, obstetrical history and education, controlling for disparities between rural and urban areas and recall period.

Results: The mean prevalence of advice reception among ANV attendees ranged from 6% (Rwanda) to 72% (Malawi); and Institutional delivery from 29% (Ethiopia) to 92% (Congo Brazzaville). Multilevel regressions on pooled data showed that compared to women with more than 4 visits, those with fewer ANV (OR=0.37; 0.56; 0.70; 0.76 for one, two, three & four ANV)were less likely to be advised. Teenagers (OR=0.84), uneducated (OR=0.65) and rural women (OR=0.70)were also less likely to have been advised, compared to women aged 20-34 years, women with secondary education and urban women respectively.Advice reception interacts with the number of ANV to increase the likelihood of institutional delivery.

Conclusion: Providers do not routinely provide women with information on pregnancy complications as part of ANV. Since ANV coverage is relatively high in SSA, increasing provider's awareness and ability in alerting users to the danger signs of potential complications and developing emergency contingency plans should be a priority for public policies.