Quality of antenatal care provision in rural villages of Satna district, Madhya Pradesh, India: a quantitative formative study to help the development of an evidence-based contextualized complex health intervention of the CHAMPION2 cluster randomized trial

Since 2005, maternal and newborn deaths have declined in India. Nonetheless, if the current mortality trends continue, India may not achieve the Sustainable Development Goal targets without enhancing the quality of care across the continuum from pregnancy to delivery, particularly in poorly performing states. This study aimed to help the development of an evidence-based contextualized CHAMPION2 trial package of maternal and child health (being implemented in rural villages of Satna district, India) by assessing the quality of, and the factors associated with antenatal care (ANC) provision across four aspects of care and exploring reasons if uptake of care was inadequate. We conducted a cross-sectional study in 50 of 196 villages in the CHAMPION2 cluster randomized trial in Satna district, Madhya Pradesh, India before randomization. We interviewed 792 women, who were eligible for the trial and had given birth in the previous two years from the interview date. We assessed the quality of ANC provision across four aspects of care (i.e., skilled care, timeliness (ANC in first trimester), number of ANC visits (at least four), and content of care) and explored women’s reasons if the uptake of care was inadequate. The quality of ANC provision was considered ‘adequate’ if all the four aspects of care were judged sufficient. We conducted logistic regression analyses to determine the socio-demographic factors associated with the adequate quality of ANC provision. Only 21.2% of women received ANC provision of ‘adequate’ quality (skilled care: 98.9%, timeliness: 75.3%, minimum four ANCs: 73.5%, and appropriate content of care: 28.3%). The inadequate quality was primarily due to inappropriate content of care, particularly poor compliance with iron-folate intake for at least 100 days and no counseling by healthcare providers on key ANC issues. The odds of receiving adequate quality ANC were increased when either the woman or husband was educated to at least high school level. The quality of ANC provision in the study setting was inadequate. The quality of care was emphasized in refresher training for nurses in the CHAMPION2 trial and health promotion, demand generation, and community mobilization activities were locally contextualized.