Maternal, Neonatal and Child Health (MNCH) is recognized as one of the main “health concerns” globally. Maternal and Child Mortality Rates are one of the main indicators globally, in addition to assessing the evolution of health in women and children, and the implementation of key interventions that they need are particularly used to assess general social and economic development of Countries (1).
Worldwide, there are several efforts to improve the health status of women and children, from universal access to primary health care, childbirth care, newborn care and continuous care for women and children (two).
The prenatal consultation (ANC) represents the moment when a pregnant woman maintains contact with a qualified health professional, and has the opportunity to carry out medical examinations, evaluation, observation, treatment and education so that the pregnancy, delivery and the birth, become a normal process and without danger for the woman and the child (3, 2).
The ANC is also an opportunity to promote the use of specialized assistance during childbirth and the practice of healthy behaviours such as breastfeeding, early postpartum control and planning for an optimal spacing of pregnancy, contributing substantially to the reduction of maternal mortality. and infantile (2, 3).
In 2016, within the scope of the initial implementation of the Sustainable Development Goals (SDG) 2030, avoidable morbidity and mortality related to pregnancy remained excessively high, despite the substantial progress achieved. Countries need to consolidate and increase their advances and expand their agendas beyond survival to maximize the health and potential of their populations (4).
Many countries, particularly in the developing world, are making progress in ensuring that pregnant women have at least one ANC during their pregnancy. However, the challenges are cantered on ensuring the quality of care in terms of the number of consultations carried out by these women (5). And the World Health Organization (WHO) understands that for ANC to achieve this life-saving potential for women and babies, pregnant women need to have at least four consultations, providing interventions based on essential evidence that include identification and management of obstetric complications (3).
According to the 2020 performance report by the Ministry of Health (MISAU), in Mozambique more than 98% of pregnant women had at least one ANC, however, only 59% of them managed to have four or more ANCs. Niassa province had the lowest performance with only 36% (6). This fact places this region of the country with great challenges and Mozambique needs to achieve the SDGs, taking into account the established standards of a minimum number of 4 consultations to guarantee the quality of pregnancy follow-up, as a measure to reduce the high mortality rates that the country registers.
Factors associated with not performing the BC are linked to socioeconomic conditions and low education, limited access to consultations at the place of residence far from the service; cost of commuting, low quality of health care and social support, maternal age (adolescence and older age), not living with a partner, use of alcohol or other drugs during pregnancy, multiparity, non-acceptance of pregnancy, lack of family support, adverse social context, negative experiences of care and conceptions of disbelief about prenatal care (2).
In African contexts, the use of ANC services is associated with high educational and economic levels. For example, in Ghana, 87% of postpartum women had attended ANC at least once during their last pregnancy, 95.6% had four (4) or more visits, and 77.1% started ANC in the first trimester. where 97.3% of mothers had good knowledge about the importance of ANC (7).
In the same way that long distances to the US and the lack of financial availability to obtain transportation to reach the US represent economic factors that are associated with the non-use of prenatal services by pregnant women (8, 9).
New maternal age has been identified as a factor associated with the use of antenatal care services (7).
In a study carried out in Nampula on prenatal care, the number of consultations and gestational age at the beginning of prenatal care were related, and it was found that puerperal women attended prenatal consultations, but only 39.9% started prenatal care. natal until the 16th week of pregnancy. And the reasons for late initiation of the BC and having less than 4 consultations were highlighted as being: not finding it important to have several consultations; not having easy access to the health facility; not knowing I was pregnant; and not having a companion for consultations (10).
Although socioeconomic factors have been reposted as associated with performing ANC, in various contexts in the world and in Africa, in particular, in Mozambique there is still insufficient information on the contextual challenges linked to having 4 or more ANC.
Understanding the factors linked to adherence to ANC services is a priority and a potential contribution to the government's agenda for reducing maternal and neonatal mortality.
This research aimed to analyse the influence of socioeconomic, demographic and obstetric factors on the performance of 4 or more ANC at the health facility of Cuamba, Province of Niassa.