This paper examines the utilization of antenatal care and out come of pregnancy and delivery complications (Reproductive risk) among currently married women in Andhra Pradesh, India. Data for this study were collected from DLHS-RCH-3 for Andhra Pradesh. Pregnancy outcome has been collected for all deliveries from the currently married women and the utilisation of ANC, health seeing behavior, pregnancy problems during and problems during delivery which have been considered as reproductive risk and analysed for the last child data. Reproductive history of 19825 deliveries for Andhra Pradesh form data set. Analysis has been carried out in three stages. Initially Pregnancy loss and its ANC and treatment seeking behavior have been analysed. At the second stage pregnancy complications and delivery complications for the last delivery in relation to outcome has been analysed for Andhra Pradesh data. At the third stage interrelation between Pregnancy out come and reproductive risk has been analysed by using logistic regression. Further influence of background variables on reproductive loss and treatment seeking behavior has been analysed. The results revealed that women experience still birth in Andhra Pradesh found to be around 2.9. Further results revealed that women who had utilized antenatal care services found to have less risk in delivering last child than other. Maternal age and husband occupation played significant influence in utilization of health care services leading to safe delivery in these two selected states.

1. Does Utilization of Antenatal Care Reduces Reproductive
Risk: A Case Study of Andhra Pradesh
By
Dr. C.P.Prakasam
Retired Professor, International Institute for Population Sciences,
Mumbai, India
prakasamcp60@gmail.com
Abstract:
This paper examines the utilization of antenatal care and out come of pregnancy and delivery
complications (Reproductive risk) among currently married women in Andhra Pradesh. Data for
this study were collected from DLHS-RCH-3 for Andhra Pradesh. Pregnancy outcome has been
collected for all deliveries from the currently married women and the utilisation of ANC, health
seeing behavior, pregnancy problems during and problems during delivery which have been
considered as reproductive risk and analysed for the last child data. Reproductive history of 19825
deliveries for Andhra Pradesh form data set. Analysis has been carried out in three stages. Initially
Pregnancy loss and its ANC and treatment seeking behavior have been analysed. At the second
stage pregnancy complications and delivery complications for the last delivery in relation to
outcome has been analysed for Andhra Pradesh data. At the third stage interrelation between
Pregnancy out come and reproductive risk has been analysed by using logistic regression. Further
influence of background variables on reproductive loss and treatment seeking behavior has been
analysed. The results revealed that women experience still birth in Andhra Pradesh found to be
around 2.9. Further results revealed that women who had utilized antenatal care services found to
have less risk in delivering last child than other. Maternal age and husband occupation played
significant influence in utilization of health care services leading to safe delivery in these two
selected states.

2. Introduction:
The Reproductive and child health programs (RCH) and recently introduced NRHM program by
Government of India focuses on maternal and child health care, skilled medical assistance during
pregnancy as well as child birth, are and other services for institutional or home delivery and post-
partum services. Availability of health care facilities within the vicinity will help to receive
antenatal care in time, which enables to identify the medical condition of pregnant women such as
malnutrition, anemia and helps women to prepare for the child birth. Non availability of health
facilities or poor access to it may contribute to increase in maternal mortality. Access to health
care facilities is a primary strategy for improving utilization of health services. In the recently
introduced NRHM program, an attempt is made to develop linkages between health care facilities
and pregnant rural women through Accredited Social Health Activist (ASHA).Research studies
revealed that accessibility to health care facilities alone will not improve the utilization of such
services if the quality of services is not maintained along with Socio economic conditions (Das et
al 2001, Beegle et al 1998)
Quality of health care services to pregnant women will lead to safe delivery and reduces maternal
mortality. It is expected that a pregnant women must go for her first ANC visit in the first trimester
provided in a health facility or receives at home by ANM or by health visitor. It is also required
that pregnant women should have at least three ANC visits and take Tetanus Toxoid injection to
prevent infections to save the lives of mother and child. Iron and folic acid (IFA) tablets were
supplied to pregnant women to prevent as well as treatment for anemia. Pregnant women must
take at least 100 and above IFA tablets during her pregnancy and at least three antenatal check-
ups should be given to the mother before delivery. Providing ANC, TT and IFA tablets to the
pregnant women as per requirement will assure pregnant women will and save safe delivery and
reduces maternal and child mortality. (TT) injection to avoid Pregnancy related health is starts
with antenatal care, which involves examining the pregnant women and conducting of physical
examination by a skilled health personal.
Research studies reveal that availability of health care facilities and accessibility with quality care
influences the client’s decision regarding its usage (Bertrend, et. al 1995). Lack of access to
healthcare, along with poor quality of the delivery system caused many pregnancy disorders such
as: Hypertensive disorders during pregnancy (toxemia or eclampsia), still birth delivery, abortions
or post pregnancy complications. Evidences suggest that toxemia and eclampsia accounted for 13
percent of all maternal deaths (Bhatia, 1993 and Kapil, 1990).The level of utilization of the services
provided by the health personels reflects not only on the quality of service provided but also
improves the overall health situation of the reproductive women.Keeping in view of above
research work in this paper an attempt is made to understand the influence of Antenatal care
services on out come of delivery making use of RCH round of District Level Household and
Facility Survey (DLHS) on Reproductive & Child Health (RCH) carried out during 2007-08
(DLHS-RCH-3, IIPS) for the State of Andhra Pradesh.The District Level Household and Facility

3. Survey in Andhra Pradesh is part of the nationwide survey covering 611 districts from 35 states
and union territories in India. In the third round of the district level household survey was
conducted during December 2007-May 2008. DLHS-3 in Andhra Pradesh covered twenty-three
districts.(IIPS October 2009).For the present study data were derived from DLHS-3, for 21,731
ever-married women in Andhra Pradesh.
Conceptual Framework:
The theoretical framework of influencing variable in utilizing ANC and Reproductive risk is
shown in Figure 1. Theoretically, availability of ANC services influences the Utilization of such
suervices. Further with a precondition of utilization of ANC, the out come of delivery depends up
on Place of delivery and person attended the delivery. Considering these influencing factors the
reproductive risk (out come of delivery) has been studied. The availability of resours are
Government facilities for ANC, Private Facilites for ANC and Community base facilities for ANC.
The utilization of ANC services has been categoried as ANC check up during any time during
pregnance (AANC), first trimester of pregnancy (PCFT), three or more ANC (PTANC),full ANC
(PFANC) and with iron folic acid tables (PIFA).
Objectives: The objectives of the present study are:
1) To know the availability of resources for ANC and Utilization of ANC services by the
currently married women in Andhra Pradesh
2) To examine the pregnancy complications and place of delivery and the extent of safe
delivery.
3) To examine the effective Antenatal Care leading to Safe delivery (Pregnancy outcome).
Data and Methodology:
From the household questionnaire data related to currently married women in the age group
15-49 were collected.
Data pertaining to antenatal check-up, experience of pregnancy related complications,
place of delivery, have been collected from the currently Married Women’s schedule for
TAMIL NADU and ANDHRA PRADESH

4. Figure: 1: Conceputla frame work of Influencing variables in Utilization of ANC and Reproductive Risk
Availability of Resources
1. Government facilities for ANC
2. Private Facilities for ANC
3. Community base facilities for ANC
Utilization of ANC
1. Any Anti natal Check up (ANC) during
pregnancy (AANC)
2. Antenatal Check-up in the first trimester of
pregnancy (PCFT)
3. with three or more antenatal check-up
(PTANC)
4. Received full antenatal check-up (PFANC)
5. Received 100+IFA tablets/syrup (PIFA)
Place of delivery
1. Government facilities
2. Private Facilities
3. Home
Complications
1. during Pregnancy
2. during Delivery
Pregnancy
out come
1. Safe
Delivery or
2.
Pregnancy

5. Results:
The interrelation between safe deliveries leading to life birth depends upon availability
accessibility of the resources and utilization of these resources effectively leads to safe delivery.
As it is intended to measure the pregnancy outcome (life birth) it is considered as safe delivery in
this study. These concepts have been measured as:
Accessibility of resources for ANC: Government facilities for ANC, Private Facilities for ANC
Community base facilities for ANC
Utilization: Any Anti natal Check up (ANC) during pregnancy (AANC), Antenatal Check-up
in the first trimester of pregnancy (PCFT), with three or more antenatal check-up (PTANC)
Received full antenatal check-up (PFANC), Received 100+IFA tablets /syrup (PIFA)
Pregnancy Complications: Experienced any complications during pregnancy (PCOMP), had delivery
complications (PDELCOM), had post-delivery complications (PPDELCOM)
Place of Delivery: Government facilities, Private Facilities, Home
Pregnancy outcome: Who had safe delivery (PWSAFED) (Life birth delivery)
Considering above variables, comparison between Tamil Nadu and Andhra Pradesh has been done.
The results are given in Table 1.
It has been observed that majority of currently married women in Andhra Pradesh were utilizing
Private facilities for ANC followed by Government agencies. Where as in Tamil Nadu highest
percent utilized Government facilities followed by Private Facilities for ANC.
ANC is one of the major components to be utilized by the pregnant women to have safe delivery.
It has been observed around 69 percent currently married women had Anti natal Check up (ANC)
during pregnancy (AANC) and round 75 percent in Tamil Nadu. Full ANC found to be very high in Andhra
Pradesh (86%) where as in Tamil Nadu it was only 51.8%

6. Table: 1: Percentage of currently married women in Andhra Pradesh and Tamil Nadu utilizing ANC care
and services, place of delivery and Safe delivery :RCH-DLHS-3 data analysis.
Andhra Pradesh Tamil Nadu
Resources for ANC
1. Government facilities for ANC
2. Private Facilities for ANC
3. Community base facilities for ANC
46.9
50.7
2.4
62.9
36.9
0.2
Utilization
1. Any Anti natal Check up (ANC) during
pregnancy(AANC)
2. Antenatal Check-up in the first trimester of
pregnancy (PCFT)
3. With three or more antenatal check-up(PTANC)
4. Received full antenatal check-up(PFANC)
5. Received 100+IFA tablets/syrup(PIFA)
68.6
70.1
86.6
86.0
40.5
75.6
77.7
89.4
51.8
88.1
Complications
1. Experienced any complications during pregnancy
(PCOMP)
2. Had delivery complications(PDELCOM)
3. Had post-delivery complications(PPDELCOM)
42.5
45.0
79.5
48.0
37.8
89.2
Place of Delivery
1. Government facilities
2. Private Facilities
3. Home
28.9
68.9
2.2
51.1
43.0
5.8
1. Pregnancy out come
2. Who had safe delivery (PWSAFED) (LB
delivery)
76.0 95.6

7. Table 2: Association between Safe delivery and ANC services, complications and Place of delivery in
Andhra Pradesh and Tamil Nadu
Safe Delivery (No/Yes) χ2
-value
Andhra Pradesh Tamil Nadu
Resources for ANC
Government facilities for ANC (No/Yes) 77.28** 35.46**
Utilization
Received full antenatal check-up(PFANC) (No/Yes)
Received 100+IFA tablets/syrup(PIFA) (No/Yes)
31.45**
161.31**
55.70**
20.22**
Complications
Experienced any complications during pregnancy (PCOMP)
(No/Yes)
Had delivery complications(PDELCOM) (No/Yes)
10.15*
12.61**
8.43*
13.49**
Place of Delivery
Government facilities (No/Yes) 13.5** 30.75**
**p.001 *p.05
Table 3: zero order correlation of Resource for ANC, Utilization and complication variables with Safe delivery
in Tamil Nadu and Andhra Pradesh: RCH-3 data analysis.
Correlations
** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).
Above diagonal Tamil Nadu and below diagonal Andhra Pradesh correlation values depicted.
Tamil Nadu
Andhra Pradesh
safe delivery
(6454)
Received
full ANC
(6452)
Post natal
care within
two weeks
(6453)
Pregnancy
complications
any
(6453)
Delivery
complications
(6451)
Place of
Delivery
(6454)
Delivery
conducted by
skilled
personal
(384)
safe delivery 1 .093(**) -.337(**) .036(**) .046(**) -.508(**) -.563(**)
Received full ANC .178(**) 1 -.080(**) .036(**) .042(**) .057(**) -.038
Post natal care within
two weeks
.554(**) .142(**) 1 -.032(**) -.082(**) .150(**) .079
Pregnancy
complications any
.045(**) .033(*) .049(**) 1 .194(**) .070(**) -.002
Delivery complications .050(**) .031(*) .047(**) .208(**) 1 .032(*) -.010
Place of Delivery -.358(**) .003 -.188(**) .036(**) -.023 1 .010
Delivery conducted by
skilled personal
-.272(**) -.097(**) -.073(**) -.061(*) -.047 .010 1

8. Table 4:
Logit Regression analysis: Contributory variables influencing Safe Delivery in Andhra Pradesh and Tamil
Nadu: DLHS-RCH-3 Data analysis
Variable(s) entered on step 1: GOVTANC, IFA, FULL_ANC, PLACEDEL, and PCOMP.
Conclusions:
• Highest percent (62.5) of ANC facilities through Private hospitals are utilized by pregnant
women in Andhra Pradesh.
In Tamil Nadu 43.5 percent Private hospitals resources and 35 percent Government
hospitals are utilized by pregnant women.
• Nearly 87 percent pregnant women attended for three or more ANC checkups and 89.4
percent in Tamil Nadu. Whereas FULL ANC checkup found to be very low in Andhra
Pradesh (40.5) and 51.8 in Tamil Nadu.
• In Andhra Pradesh 55 percent deliveries conducted by DAI followed by Relatives (24.7)
where as in Tamil Nadu highest deliveries are conducted by Relatives (41.7) followed by
DAI (26.8) and least by Doctors (0.8)
•
References:
Das N.P. (200): Does community access affect the use of health and family welfare services in
India” National Family Health Survey Subject Report,No.18 May 2001,.
Andhra Pradesh Tamil Nadu
95.0% C. I. for EXP(B) 95.0% C. I. for EXP(B)
Exp(B) Lower Upper Exp(B) Lower Upper
GOVTANC(1) .223** .190 .261 .104** .075 .144
IFA(1) .976 .495 1.923 1.920 .659 5.590
FULL_ANC(1) 2.376 1.199 4.707 1.441 .490 4.238
PLACEDEL(1) .984** .550 1.002. .977** .540 .980
PCOMP 1.338 1.141 1.569 1.780** 1.346 2.354
Constant 37.673 24.889
-2 Log
likelihood
Nagelkerke R
Square
3754.995
.378
1414.991
.371