Coverage and Quality of Antenatal Care in the Secondary Care Hospitals in Punjab, Pakistan

Abstract

Background: Antenatal care (ANC) is a globally endorsed strategy for the early identification of maternal and fetal risks and for preventing adverse outcomes, particularly in low- and middle-income countries (LMICs). This study examines ANC coverage and quality in the context of Pakistan, highlighting service gaps and their potential impact on maternal and neonatal outcomes.

Methodology: A retrospective descriptive analysis was conducted using data extracted from the District Health Information Reports (2019–2021) and the Electronic Medical Records (EMR) system at Manawan Hospital, Lahore. ANC coverage and service quality were evaluated based on the essential package outlined by the Punjab Ministry of Health’s Minimum Standards of Service Delivery.

Results: Between 2019 and 2021, a total of 10,921,680 first ANC (ANC-1) visits were recorded across Punjab, with an average of 420 monthly ANC visits and 114 deliveries per Tehsil Headquarters Hospital. Among these, 83% were normal vaginal deliveries and 17% were cesarean sections. Despite this volume, critical service elements—such as medical record documentation, blood pressure monitoring, Tetanus Toxoid vaccination, breastfeeding counseling, and clinical treatment protocols—were inconsistently implemented.

Conclusion: The quality and coverage of ANC services in secondary care settings are influenced by systemic issues, including limited accessibility, inadequate EMR adherence, workforce capacity, diagnostic availability, and patient education. The development and integration of performance indicators are recommended to improve early detection, service quality, and pregnancy outcomes. Further research is warranted to address data gaps and strengthen ANC services in Pakistan.