Antenatal Care (ANC) in India: Importance, Guidelines, and Challenges
Introduction to Antenatal Care (ANC)
Antenatal care (ANC), also known as prenatal care, refers to the medical attention and support a woman receives during her pregnancy. In India, antenatal visits are essential to ensure the health of both the mother and the developing fetus. These visits help detect and manage complications, provide education on healthy practices, and prepare women for childbirth and parenting.
According to the World Health Organization (WHO), antenatal care plays a crucial role in reducing maternal and infant morbidity and mortality. In a country like India, where maternal health remains a major public health issue, ANC is vital to achieving the Sustainable Development Goals (SDGs), especially SDG 3, which aims to reduce maternal mortality to less than 70 per 100,000 live births.
Importance of Antenatal Visits
1. Monitoring Fetal Development
ANC helps track the growth and development of the fetus through physical examinations, ultrasounds, and blood tests.
2. Preventing Complications
Through routine tests, healthcare providers can detect conditions like anemia, gestational diabetes, preeclampsia, and infections early, reducing the risk of complications during pregnancy and childbirth.
3. Nutritional Support
Pregnant women receive essential supplements like iron, folic acid, and calcium, which are crucial for fetal development and preventing conditions like neural tube defects.
4. Health Education
Women are educated on nutrition, hygiene, breastfeeding, birth preparedness, and postnatal care.
5. Immunization
ANC provides vaccines like TT (Tetanus Toxoid) or Td (Tetanus and Diphtheria) to prevent infections during pregnancy and childbirth.
WHO and Government of India Guidelines on ANC
WHO Recommendations
• In 2016, WHO recommended a minimum of eight ANC contacts to reduce perinatal mortality and improve maternal experience.
• Indian Guidelines (as per Ministry of Health & Family Welfare)
• India follows the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) and Janani Suraksha Yojana (JSY) to promote institutional ANC.
The Indian government recommends a minimum of four ANC visits:
• 1st Visit: Before 12 weeks
• 2nd Visit: Between 14–26 weeks
• 3rd Visit: Between 28–34 weeks
4th Visit: Between 36 weeks and term
• Components of Antenatal Visit
• Each antenatal visit should include the following assessments:
1. History Taking
Includes obstetric history, menstrual history, medical and surgical history, and family history.
2. General Physical Examination
• Weight and height
• Blood pressure
• Pallor (sign of anemia)
• Edema
• Pulse rate and respiratory rate
3. Obstetric Examination
• Abdominal palpation to assess fetal position and size
• Fundal height measurement to estimate gestational age
• Fetal Heart Rate (FHR) check using a Doppler or fetoscope
4. Laboratory Investigations
• Hemoglobin level
• Urine test (for albumin and sugar)
• Blood group and Rh typing
• VDRL test (for syphilis)
• HIV and Hepatitis B testing
• Blood sugar levels
• Ultrasound scans
5. Supplementation
• Iron and Folic Acid (IFA): 100 mg elemental iron + 500 mcg folic acid daily
• Calcium: 500 mg calcium with 250 IU vitamin D twice daily
6. Vaccination
• 2 doses of Td (Tetanus and Diphtheria) given one month apart starting in the 2nd trimester.
• Nutrition and Lifestyle Advice During ANC
Dietary Recommendations
Balanced diet rich in proteins, vitamins, and minerals
• Adequate hydration
• Small, frequent meals
Lifestyle Tips
• Avoid alcohol, tobacco, and drugs
• Light physical activity like walking or prenatal yoga
• Adequate sleep (7–9 hours)
• Stress management techniques such as meditation
• Government Programs Supporting ANC in India
1. Janani Suraksha Yojana (JSY)
A cash assistance scheme under the National Health Mission to promote institutional delivery and antenatal care.
2. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)
• Provides free ANC services on the 9th of every month at government health facilities.
• Focuses on high-risk pregnancies with a color-coded system.
3. Mother and Child Tracking System (MCTS)
A digital platform to track the health services received by pregnant women and children.
4. LaQshya Program
• Aims to improve the quality of care in labor rooms and maternity operation theaters.
• Emphasizes respectful maternity care and early identification of complications.
Challenges in ANC Delivery in India
Despite the robust policies and schemes, several challenges exist in providing effective antenatal care across the country.
1. Rural-Urban Disparity
Access to quality healthcare remains a challenge in remote and tribal areas due to lack of infrastructure, transportation, and trained staff.
2. Lack of Awareness
Many women are unaware of the importance of ANC, especially in rural regions with lower literacy rates.
3. Socio-Cultural Barriers
Social norms, gender biases, and taboos often prevent women from seeking early and regular care.
4. Staff Shortages
There is a scarcity of skilled healthcare professionals such as obstetricians, ANMs (Auxiliary Nurse Midwives), and ASHAs in many parts of the country.
5. Inadequate Record-Keeping
Manual data entry, poor documentation, and lack of digital health records can hinder follow-ups and continuity of care.
Digital Innovations Supporting ANC
1. e-Mamta
A mother and child health tracking system developed by the Government of Gujarat to monitor ANC services.
2. mHealth Applications
Apps like Kilkari and mMitra send voice messages to pregnant women with stage-based health information.
3. Telemedicine
Especially during the COVID-19 pandemic, telemedicine emerged as a powerful tool to reach expecting mothers in remote areas.
Role of Community Health Workers
1. ASHA Workers
They act as a bridge between the healthcare system and the community. They encourage ANC visits, distribute IFA tablets, and accompany women to health facilities.
2. ANMs and Anganwadi Workers
They conduct outreach sessions, provide basic ANC services, and record vital data of pregnant women.
• How to Prepare for Your Antenatal Visit
• Carry your Mother and Child Protection (MCP) Card
Note down any symptoms or concerns
• Follow a list of questions to ask your doctor (e.g., about fetal movements, diet, labor signs)
• Wear loose clothing for easy examination
When to Seek Immediate Medical Attention
During pregnancy, a woman should immediately contact her healthcare provider if she experiences:
• Severe abdominal pain or cramping
• Vaginal bleeding
• Persistent vomiting or fever
• Blurred vision or severe headaches
• Decreased fetal movement
• Swelling of hands, face, or feet
FAQs on Antenatal Visits in India
1. How many antenatal visits are necessary during pregnancy?
The WHO recommends 8 contacts, but the Indian guideline advises at least 4 ANC visits at different stages of pregnancy.
2. Are antenatal services free in India?
Yes. Under schemes like JSY and PMSMA, antenatal care is provided free of cost in government facilities.
3. What happens if a mother misses her ANC visits?
Missing ANC visits can lead to delayed diagnosis of complications, affecting both maternal and fetal outcomes. Regular visits are critical for safe pregnancy.
4. Can working women manage ANC visits?
Yes. It’s advisable to schedule appointments in advance, take prenatal leave when needed, and opt for evening ANC clinics available in urban centers.
5. Is ANC different for high-risk pregnancies?
Yes. Women with high-risk pregnancies (e.g., hypertension, diabetes, twins) need more frequent visits and specialized monitoring.
Conclusion
Antenatal care is a cornerstone of maternal and child health in India. Despite significant strides made through government programs and digital interventions, challenges remain in access, awareness, and quality of care. By promoting early registration, consistent visits, and health education, India can move closer to its goal of safe motherhood and reduced maternal mortality.
Every antenatal visit is an opportunity to save two lives — the mother and the baby.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)