International Journal of Research and Reports in Gynaecology

Background: Early antenatal care is an important entry point for maternal health services; however, improvements in coverage may not be equally distributed across population groups and countries. This study examined temporal patterns, socioeconomic disparities and cross-country heterogeneity in first antenatal care (ANC1) coverage across 168 countries between 2000 and 2023.

Methods: A repeated cross-sectional country-year panel dataset comprising 699 observations was analysed using secondary data from global UNICEF sources. National ANC1 coverage was assessed alongside subgroup differences by residence, wealth and adolescent status. Inequality was examined using absolute gaps and gradient-based measures, including the Slope Index of Inequality and the Relative Index of Inequality. Multilevel mixed-effects models, fractional response models, robust regression, variance decomposition and clustering approaches were used to assess temporal trends, inequality patterns and heterogeneity across countries, regions and income groups.

Results: Mean global ANC1 coverage was 87.3%, with predicted coverage increasing from 77.49% in 2000 to 96.74% in 2023. Despite this progress, disparities persisted across regions and socioeconomic groups. The region with the lowest mean coverage was South Asia (68.30%), and the largest wealth-related gap was found in South Asia (35.35 percentage points). Coverage was lower in the lower-income countries, and urban-rural and wealth gaps were higher than in higher-income countries. The coverage of national ANC1 was strongly correlated with low wealth-related inequality, with a model coefficient of -0.855. The results of variance decomposition indicated that the largest proportion of the variance in the inequality of wealth explained was for national coverage.

Conclusion: There was a significant rise in ANC1 coverage from 2000 to 2023, although there was still some variation in the extent of this coverage. The findings indicate that the expansion of maternal health service coverage should be accompanied by equity-focused strategies targeting poorer, rural and underserved populations.