Global, Regional, and National Estimates of Complete Coverage of Maternal Obstetric Care Interventions, 1990-2019

Abstract

Introduction: Tracking coverage of maternal obstetric care interventions is a major component of policies and programs aimed at reducing maternal and child mortality around the world. Previous work quantifying coverage of these interventions has been limited in scope and cross-national comparability. In this analysis, we estimate coverage of five essential maternal obstetric care interventions and a new indicator of receipt of the full maternal obstetric care continuum. Methods: We synthesized 898 unique data sources covering 4,141 unique country-years of data to model coverage of antenatal care (4+ visits), in-facility delivery, skilled birth attendance, caesarean section delivery, postnatal care, and full maternal care coverage. We used a 3-step spatiotemporal Gaussian process regression modeling technique to produce estimates of coverage at the global, regional, and national levels from 1990 to 2019. Results: In 2019, we estimate 68.3% (95% UI 67.5 – 69.1) of women received four or more antenatal care visits during pregnancy, 81.1% (80.1 – 82.2) of women gave birth in a health facility, 83.1% (82.1 – 84.0) of births were attended by a skilled birth attendant, 22.3% (21.2 – 23.5) of births were delivered via caesarean section, and 70.5% (69.8 – 71.1) of women received a postnatal care visit within two days of delivery. We estimate that 56% (55.1 – 56.9) of women received the recommended full continuum of maternal care indicators. While significant progress has been made in expanding coverage since 1990, we demonstrate large remaining geographic coverage gaps. These gaps resulted in an estimated 58.3 million live births in 2019 that were not covered by the full continuum of recommended maternal obstetric care interventions. Discussion: While significant progress has been made in expanding access to essential maternal obstetric care interventions, coverage remains comparatively low in regions with the highest maternal and child morbidity and mortality. Estimates of intervention coverage can help policymakers and practitioners identify locations for program and policy focus, and estimates of full maternal care coverage expand beyond traditional monitoring frameworks and focus on the full maternal obstetric care continuum and health systems’ capacity to provide care throughout the duration of pregnancy, delivery, and post-partum.