IS ANTENATAL CARE EFFECTIVE IN REDUCING MATERNAL MORBIDITY AND MORTALITY

Women in developing countries are dying from simple preventable condit ions but what impact can the procedures collectively called antenatal care have in reducing maternal mortality and morbidity? More important ly what is antenatal care? This review found that questions have been raised about the impact of antenatal care (specifically on maternal mo rtality) since its inception in developed countries, and that although the questions continue to be asked there is very little research tryi ng to find answers. Many antenatal procedures are essentially screenin g tests yet it was found that there were very few results showing sens itivity and specificity, and that they rarely complied with the establ ished criteria for the effectiveness of a screening test. The acknowle dged gold standard measurement of effectiveness is the randomized cont rolled trial, yet the only results available referred to nutritional s upplementation. This service of flawed methodology has been exported t o developing countries and is being promoted by WHO and other agencies . This paper argues that there is insufficient evidence to reach a fir m decision about the effectiveness of antenatal care, yet there is suf ficient evidence to cast doubt on the possible effect of antenatal car e. Research is urgently required in order to identify those procedures which aught to be included in the antenatal process. In the final ana lysis the greatest impact will be achieved by developing a domiciliary midwifery service supported by appropriate local efficient obstetric services. That this domiciliary service should provide care for women in pregnancy is not disputed but the specific nature of this care need s considerable clarification.