Doubova, Svetlana V., Quinzaños Fresnedo, Claudio, Paredes Cruz, Martín, Perez-Moran, Diana, Pérez-Cuevas, Ricardo, Meneses Gallardo, Verónica, Garcia Cortes, Luis Rey, Cerda Mancillas, Megan Carolina, Martínez Gaytan, Victoria, Romero Garcia, Miguel Angel, Espinoza Anrubio, Gilberto, Perez Ruiz, Claudia Elsa, Prado-Aguilar, Carlos A., Sarralde Delgado, Augusto, Kruk, Margaret E., and Arsenault, Catherine
Background: Comprehensive antenatal care (ANC) must prioritize competent, evidence-based medical attention to ensure a positive experience and value for its users. Unfortunately, there is scarce evidence of implementing this holistic approach to ANC in low- and middle-income countries, leading to gaps in quality and accountability. This study assessed care competence, women's experiences during the first ANC visit, and the factors associated with these care attributes. Methods and findings: The study analyzed cross-sectional baseline data from the maternal eCohort study conducted in Mexico from August to December 2023. The study adapted the Quality Evidence for Health System Transformation (QuEST) network questionnaires to the Mexican context and validated them through expert group and cognitive interviews with women. Pregnant women aged 18 to 49 who had their first ANC visit with a family physician were enrolled in 48 primary clinics of the Instituto Mexicano del Seguro Social across 8 states. Care competence and women's experiences with care were the primary outcomes. The statistical analysis comprised descriptive statistics, multivariable linear and Poisson regressions. A total of 1,390 pregnant women were included in the study. During their first ANC visit, women received only 67.7% of necessary clinical actions on average, and 52% rated their ANC experience as fair or poor. Women with previous pregnancies (adjusted regression coefficient [aCoef.] −3.55; (95% confidence intervals [95% CIs]): −4.88, −2.22, p < 0.001), at risk of depression (aCoef. −3.02; 95% CIs: −5.61, −0.43, p = 0.023), those with warning signs (aCoef. −2.84; 95% CIs: −4.65, −1.03, p = 0.003), common pregnancy discomforts (aCoef. −1.91; 95% CIs: −3.81, −0.02, p = 0.048), or those who had a visit duration of less than 20 minutes (<15 minutes: aCoef. −7.58; 95% CIs: −10.21, −4.95, p < 0.001 and 15 to 19 minutes: aCoef. −2.73; 95% CIs: −4.79, −0.67, p = 0.010) and received ANC in the West and Southeast regions (aCoef. −5.15; 95% CIs: −7.64, −2.66, p < 0.001 and aCoef. −5.33; 95% CIs: −7.85, −2.82, p < 0.001, respectively) had a higher probability of experiencing poorer care competence. Higher care competence (adjusted prevalence ratio [aPR] 1.004; 95% CIs:1.002, 1.005, p < 0.001) and receiving care in a small clinic (aPR 1.19; 95% CIs: 1.06, 1.34, p = 0.003) compared to a medium-sized clinic were associated with a better first ANC visit experience, while common pregnancy discomforts (aPR 0.94; 95% CIs: 0.89, 0.98, p = 0.005) and shorter visit length (aPR 0.94; 95% CIs: 0.88, 0.99, p = 0.039) were associated with lower women's experience. The primary limitation of the study is that participants' responses may be influenced by social desirability bias, leading them to provide socially acceptable responses. Conclusions: We found important gaps in adherence to ANC standards and that care competence during the first ANC visit is an important predictor of positive user experience. To inform quality improvement efforts, IMSS should institutionalize the routine monitoring of ANC competencies and ANC user experience. This will help identify poorly performing facilities and providers and address gaps in the provision of evidence-based and women-centered care. Svetlana V. Doubova and co-workers explore antenatal care across Mexico using data collected from >1300 pregnant women who reported their individual lived experiences. Author summary: Why was this study done?: High-quality antenatal care (ANC) is crucial for preventing, detecting, and managing maternal and newborn complications. It involves providing comprehensive care, prioritizing evidence-based medical attention, and ensuring positive experiences for women. How healthcare providers treat women during the first ANC visit is vital in determining their satisfaction and subsequent use of health services. There is little evidence of the implementation of this holistic approach to ANC in Latin America and other low- and middle-income countries. What did the researchers do and find?: The study used baseline data from the maternal eCohort in Mexico, collected through validated global QuEST network questionnaires adapted to the local context. The study gathered and analyzed an extensive number of user-reported experience measures and multiple health status variables to comprehensively assess women's experiences and healthcare competency during the first ANC visit, serving as a valuable model for other Latin American and low- and middle-income countries. Compared to prior studies in this field, which typically gather information within a 1-year recall period, we used a 2-week data collection timeline to minimize recall bias. We found that higher care competence was associated with a higher likelihood of women rating their care as high quality and reporting positive experiences during the first ANC visit. The study's main limitation is the potential for participants' answers to be influenced by social desirability bias (i.e., what they think others want to hear), leading to responses they believe are socially acceptable. What do these findings mean?: Evidence on care competence and women's experiences should inform efforts to improve ANC quality in Mexico and Latin America. Care competence is an important determinant of client satisfaction. The gaps in care competence should be addressed to ensure positive experiences during pregnancy. [ABSTRACT FROM AUTHOR]