Effect of antenatal care on birth outcomes in The Gambia: a propensity score matching analysis

Abstract

Background The prevalence of low birth weight (LBW) is disproportionately high in developing countries, particularly in African countries. LBW infants have a greater risk of mortality and suffer from physical and cognitive impairment. Adequate antenatal care (ANC) can improve birth outcomes and mitigate the risk of LBW; however, there is limited evidence on the effectiveness of ANC on birth outcomes in resource-poor settings. The objective of this study was to estimate the causal association between ANC and birth outcomes in the Gambia. Methods The 2019-20 Gambian Demographic and Health Survey (GHDS) was used for the analysis. The GHDS collected birth weight information for 8,362 children born in the five years preceding the survey. After excluding observations with missing birth weight information, the final analytical sample included 4,443 children. A multivariate regression model and propensity score matching method were used to assess the associations between ANC and birth outcomes. The regression models were adjusted for sex and birth order of the child, maternal age and education, wealth quintiles, marital status, rural area, number of children under five years of age, and region fixed effects. Results Multivariate regression analysis revealed that one additional ANC visit increased birthweight by 22 grams and the probability of LBW by 1.2 percentage points. Mothers who had four or more ANC visits (ANC 4+) had a 3.9 percentage point lower likelihood of giving birth to LBW infants than mothers with fewer than four ANC visits. The matching analysis revealed that the average treatment effect of ANC 4 + was a 71-gram increase in birth weight and a 4.7 percentage point reduction in LBW. Conclusions Having more ANC visits is associated with improved birth outcomes in Gambia after controlling for the socioeconomic status of the households. Thus, it is important to design health policies that can ensure that women have adequate ANC visits during pregnancy to reduce the disproportionate burden of LBW in countries with limited resources.