# Utilization of Antenatal Healthcare Services, Associated Factors, and Pregnancy Outcomes Among Postnatal Women Who Delivered in Selected Rural Healthcare Centers in Odisha, Southeastern India

## TL;DR

This study examines antenatal care use and its impact on pregnancy outcomes among women in rural India, finding that poor ANC utilization is linked to adverse outcomes.

## Contribution

The study identifies specific factors affecting antenatal care use and their association with pregnancy complications in a low-resource Indian setting.

## Key findings

- Only 69.6% of women attended four or more recommended antenatal visits.
- Poor ANC utilization was linked to higher risks of pregnancy complications and post-term births.
- Maternal knowledge significantly influenced ANC service use.

## Abstract

Background: Adverse pregnancy outcomes remain a prevalent health issue in India. Many of the negative consequences could be avoided if mothers used prenatal care. However, in many low-resource Indian situations, the use of this service and its drivers has not been thoroughly studied. Therefore, this study was conducted to assess the utilization of antenatal care (ANC) services and the various factors affecting this utilization and pregnancy outcomes.

Material and methods: A cohort study was conducted among 326 recently delivered mothers in Khordha District, Odisha, in the southeastern community of India. A multistage sampling technique was used to select the desired sample. Demographic variables were obtained through a structured demographic proforma; maternal knowledge was evaluated using a structured knowledge questionnaire; and a factor-related structured questionnaire was used to identify factors associated with ANC service utilization. An interview method was used to collect the information from the participants. The data were entered using EpiData version 1.4.4.0 (Buenos Aires, Argentina) and exported to IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York) for analysis. Bivariate and multiple logistic regressions were applied to identify participants and predictor variables, respectively.

Results: This study revealed that 227 (69.6%) had attended four or more recommended antenatal visits. The main perceived barriers to ANC access were unplanned pregnancy, delay in pregnancy confirmation, uncooperative partner, lack of family support, and distance from the health facility. It was found that 287 (88.1%) of women had adequate knowledge about the danger signs of pregnancy, and 174 (53.4%) were aware of available ANC health services in their locality. Knowledge of women was revealed to be a major factor impacting the utilization of ANC health services in this study (crude odds ratio (cOR) 24.03; 95%CI 12.37-46.65; p<0.01). It is also found that poor antenatal utilization was associated with an increased likelihood of complications arising during the antenatal period (cOR 2.43; 95%CI 0.34-18.71, p=0.01), immediate postnatal complications (cOR 1.77; 95%CI 2.43 0.83-17.15; p=0.02), cesarean section and operative vaginal delivery rate (cOR 1.88; 95%CI 1.11-3.17; p=0.03), and post-term babies (cOR 5.64; 95% CI 1.31-24.4; p=0.01).

Conclusion: The utilization of WHO-recommended ANC service in the present study area was found to be poor. The quality of ANC and maternal awareness among the population were found to be the factors that influence women's good utilization of ANC. Underutilization of ANC health services had a significant impact on adverse pregnancy outcomes, such as complications that arise during the antenatal and immediate postnatal period, cesarean sections, and operative vaginal delivery rates, as well as post-term pregnancy. These results can be utilized to develop a health intervention program to enhance maternal health utilization practices and, ultimately, improve maternal and child health quality in low-resource settings in India.