Maternal and Child Health Journal

, Volume 20, Issue 2, pp 281–289 | Cite as

Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa

  • Kavita SinghEmail author
  • William T. Story
  • Allisyn C. Moran



We assess how countries in regions of the world where maternal mortality is highest—South Asia and Sub-Saharan Africa—are performing with regards to providing women with vital elements of the continuum of care.


Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care—at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 h since birth. Family planning counseling within a year of birth was also included in the descriptive analyses.


Results indicated that a major drop-out (>50 %) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (<5 %) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements.


Understanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health.


Antenatal care Continuum of care Family planning Maternal health PNC Skilled delivery South Asia Sub-Saharan Africa 



This study was funded by the United States Agency for International Development (USAID) through a cooperative agreement (GHA-A-00-08-00003-00) with MEASURE Evaluation. The views expressed in this paper do not necessarily reflect those of USAID. This work was also supported in part by an R24 Center Grant (R24 HD050924) and a T32 Training Grant (T32 HD007168) to the Carolina Population Center at the University of North Carolina at Chapel Hill.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kavita Singh
    • 1
    • 2
    Email author
  • William T. Story
    • 1
  • Allisyn C. Moran
    • 3
  1. 1.MEASURE Evaluation/Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Global Health Fellows Program IIUnited States Agency for International Development (USAID)WashingtonUSA

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