A comprehensive assessment of care competence and maternal experience of first antenatal care visits in Mexico: Insights from the baseline survey of an observational cohort study

Svetlana V. Doubova, Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Claudio Quinzaños Fresnedo, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Martín Paredes Cruz, Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Diana Perez-Moran, Unidad de Investigación Epidemiológica y Servicios de Salud del CMN SXXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Ricardo Pérez-Cuevas, Division of Social Protection and Health, Interamerican Development Bank, Washington, DC, United States of America.
Verónica Meneses Gallardo, Unidad de medicina Familiar 31, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Luis Rey Garcia Cortes, OOAD Estado de México Oriente, Instituto Mexicano del Seguro Social, Tlalnepantla de Baz, Estado de México, México.
Megan Carolina Cerda Mancillas, OOAD Coahuila, Instituto Mexicano del Seguro Social, Saltillo, Coahuila, México.
Victoria Martínez Gaytan, Unidad Médica de Alta Especialidad, Hospital de Gineco obstetricia N°23 Dr. Ignacio Morones Prieto, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
Miguel Angel Romero Garcia, Jefatura de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Monterrey, Nuevo León, México.
Gilberto Espinoza Anrubio, OOAD DF Sur, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Claudia Elsa Perez Ruiz, OOAD Veracruz Norte, Instituto Mexicano del Seguro Social, Veracruz, México.
Carlos A. Prado-Aguilar, OOAD Aguascalientes, Instituto Mexicano del Seguro Social, Aguascalientes, México.
Augusto Sarralde Delgado, OOAD Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México.
Margaret E. Kruk, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Catherine Arsenault, Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States of America.

Document Type

Journal Article

Publication Date

9-1-2024

Journal

PLoS medicine

Volume

21

Issue

9

DOI

10.1371/journal.pmed.1004456

Abstract

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.

Department

Global Health

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