Evaluation of antenatal care follow-up among pregnant women registered at training family health centers

Authors

Abstract

AimThis study aimed to evaluate the utilization and quality of antenatal care (ANC) services among pregnant women registered at training family health centers.
MethodsThis descriptive study was conducted between July 1, 2024, and November 1, 2024. A total of 173 pregnant women registered at Sakarya Zümrüt Müftüoğlu and Karaman No. 2 Family Health Centers between November 4, 2022, and June 7, 2024, were evaluated. Pregnancy follow-up data were obtained from electronic medical records, and additional sociodemographic and pregnancy-related data were collected through telephone interviews using a structured 12-item questionnaire. Telephone interviews were completed with 138 participants. Among them, 86 women who completed four recommended ANC follow-up visits were included in the ANC quality score analysis.
ResultsAmong the 138 respondents, the mean age was 29.66 ± 4.62 years, and most were married (98.6%). Among women included in the ANC quality analysis, 79.1% had adequate tetanus immunization. In women with complete electronic follow-up records, routine ANC components, including body weight measurement, blood pressure measurement, blood testing, fetal heart sound monitoring, and iron supplementation, were recorded at high rates. The mean ANC service score was 5.62 ± 0.71, and 70.9% of participants achieved the maximum score. No significant association was found between ANC scores and sociodemographic or pregnancy-related characteristics (p > 0.05).
ConclusionANC services were generally of high quality; however, strengthening counseling services may further improve the comprehensiveness of care.

Keywords

Introduction

Women’s health plays a fundamental role in ensuring healthy pregnancies and future generations and has a direct impact on public health. In developing countries in particular, complications arising during pregnancy and childbirth remain among the leading causes of maternal and neonatal mortality.¹ This situation highlights the increasing importance of antenatal care (ANC) services. Antenatal care is critical not only for preventing pregnancy-related complications but also for protecting the health of both the mother and the infant throughout the pregnancy process.² Effective ANC requires a holistic approach that addresses women’s health needs across physical, mental, and social dimensions.^1,2
Pregnancy is a significant life period associated with profound changes in a woman’s physical and psychological balance. Each year, a considerable number of women die due to preventable health conditions; however, this burden can be substantially reduced through the provision of preventive healthcare services.³ Antenatal care involves informing women about the pregnancy process, providing immunization against infectious diseases, and monitoring fetal development, all of which aim to safeguard maternal and child health. Through regular examinations and follow-up visits, ANC facilitates the early detection of health problems and contributes to the reduction of maternal and neonatal mortality.^4,6 In Türkiye, although the utilization rate of ANC services reached 96% in 2018, there remains a persistent need to improve the adequacy and quality of these services.²
During the antenatal care process, women should receive counseling on key topics such as nutrition, hygiene, physical activity, oral and dental health, tetanus vaccination, and potential pregnancy-related risk factors. In the later stages of pregnancy, glucose screening tests should be performed, and fetal biometric measurements and heart rate assessments should be conducted using ultrasonography. In addition, pregnant women should be informed about physiological changes during pregnancy and the postpartum period. Such educational interventions increase awareness of healthy weight gain, monitoring of fetal movements, and birth preparedness, thereby improving the likelihood of a healthy pregnancy outcome. During physical examinations, the overall health status of expectant mothers should be carefully evaluated, and referrals to dietitians or other specialized healthcare professionals should be made when necessary. Early identification and management of conditions such as anemia, edema, or hypertension may reduce potential risks for both the mother and the fetus.⁷
The aim of this study is to examine how pregnant women registered at training family health centers affiliated with a teaching and research hospital in Türkiye benefit from ANC services. In this context, the study seeks to evaluate the extent to which ANC services meet the needs of pregnant women, identify factors influencing the accessibility of these services, and determine the strengths and weaknesses of the current ANC system in order to propose recommendations for improvement. Such an evaluation may represent an important step toward enhancing the quality of healthcare services and could contribute positively to maternal and neonatal health outcomes in the long term. Strengthening antenatal care services, particularly in regions with high maternal and infant mortality rates, may offer effective solutions for improving health service delivery.

Materials and Methods

Study DesignThis descriptive study was conducted between July 1, 2024, and November 1, 2024.
Study Population and Setting
The study population consisted of pregnant women registered at Sakarya Zümrüt Müftüoğlu and Karaman No. 2 Family Health Centers. A total of 173 pregnant women who applied to these centers between November 4, 2022, and June 7, 2024, were included in the study. No sampling method was applied; all registered pregnant women were evaluated.
Data CollectionPregnancy follow-up data were obtained by reviewing the electronic medical record systems of the relevant family health centers. Data not available in the electronic records, including sociodemographic characteristics and pregnancy-related information, were collected through telephone interviews with the participants. A structured 12-item questionnaire was administered.
Assessment of Antenatal Care QualityTo evaluate the quality of antenatal care (ANC) services, a scoring system was used. Each of the following ANC components was assigned one point if provided: tetanus vaccination, measurement of body weight, measurement of blood pressure, performance of blood tests, auscultation of fetal heart sounds, and use of iron supplementation. Based on these criteria, a total ANC service score of 0 to 6 was calculated for each participant.
Ethical ApprovalEthical approval for this study was obtained from the Sakarya University Faculty of Medicine Non-Interventional Research Ethics Committee (June 27, 2024; Decision No: E-71522473-050.04-372965-175). Written and verbal informed consent was obtained from all participants prior to data collection. The study was conducted in accordance with the Declaration of Helsinki.
Statistical AnalysisData were analyzed using SPSS version 27. Descriptive statistics were presented as percentages and measures of central tendency, including mean, standard deviation, median, and interquartile ranges. The normality of data distribution was assessed using the Shapiro–Wilk test. For comparisons of categorical variables, Pearson’s chi-square test and Fisher’s exact test were used as appropriate. For comparisons of continuous variables with a normal distribution, the Student’s t-test was applied. A p-value < 0.05 was considered statistically significant within a 95% confidence interval.
Reporting GuidelinesThis study is reported in accordance with the STROBE guidelines for observational studies.

Results

Participant FlowA total of 173 pregnant women were evaluated within the scope of the study. Telephone interviews were successfully completed with 138 participants, whereas 35 women could not be reached. Among the interviewed women, 86 pregnant women who had completed all four recommended antenatal care (ANC) follow-up visits were included in the ANC service quality score analysis. In addition, selected ANC service components documented in the electronic follow-up records were evaluated in the subgroup of women with complete follow-up data available in the system (Figure 1).
Sociodemographic and Pregnancy-Related CharacteristicsThe sociodemographic and pregnancy-related characteristics of the interviewed participants are presented in Supplementary Table 1. Among the 138 respondents, 98.6% were married, and the mean age of the overall study population was 29.66 ± 4.62 years. In terms of educational status, 39.1% of the participants were high school graduates, and 39.9% had a university degree. Most women were unemployed during pregnancy (71.0%). Smoking during pregnancy was reported by 10.9% of the respondents, whereas passive smoking exposure was identified in 5.7% of non-smokers.
Regarding pregnancy-related characteristics, 23.9% of the interviewed participants reported that the pregnancy was unintended. Slightly more than half of the women were experiencing their first pregnancy, whereas the remainder had had more than one pregnancy. High-risk pregnancy status was reported by a minority of participants.
Utilization of Antenatal Care Service ComponentsThe denominators used in the analysis varied according to the data source and the completeness of available records. Tetanus immunization status was evaluated among women who had completed all four ANC visits and also participated in the telephone interview (n = 86). In contrast, routinely recorded ANC service components were assessed among women with complete electronic follow-up records for all four visits (n = 98). The utilization of ANC service components is presented in Supplementary Table 2.
Among the 86 women included in the ANC quality score analysis, 79.1% had adequate tetanus immunization. In the subgroup with complete four-visit electronic follow-up records, body weight measurement was documented in 99.0% of participants, blood pressure measurement in 96.9%, blood testing in 99.0%, fetal heart sound monitoring in 91.8%, and iron supplementation in 96.9%. Overall, these findings indicate that the routinely recorded clinical components of ANC were delivered at high rates among women with complete follow-up records.
Antenatal Care Service Quality ScoresEach ANC component was assigned one point, resulting in a total ANC service score ranging from 0 to 6. ANC service quality scores are shown in Supplementary Table 3. Among the 86 participants included in the score analysis, 70.9% achieved the maximum score of six points, 23.3% scored five points, 2.3% scored four points, and 3.5% scored three points. The mean ANC service score was 5.62 ± 0.71, with a median of 6 and a range of 3 to 6. These findings show that ANC service quality was generally high among women who completed the recommended follow-up schedule.
Counseling ServicesOverall, 79.5% of the interviewed participants reported receiving counseling services during pregnancy. Counseling most frequently addressed nutrition and diet (68.4%), followed by pregnancy-related discomforts (50.3%). Other counseling topics included physical activity, sexual health, hygiene, medication use during pregnancy, warning signs, birth preparation, breastfeeding, tetanus vaccination, and emergency situations. Although counseling services were reported by the majority of participants, the distribution of topics suggests that some aspects of counseling may have been addressed less consistently than the routine clinical components of ANC.
Factors Associated with ANC Service ScoresComparisons of ANC service scores according to selected sociodemographic and pregnancy-related characteristics are presented in Supplementary Table 4. No statistically significant differences were found between ANC service scores and education level, employment during pregnancy, healthcare professional status of the participant or spouse, exposure to cigarette smoke, pregnancy intention, number of pregnancies, or high-risk pregnancy status (p>0.05 for all). Mean age also did not differ significantly between women who received full scores and those who received partial scores (p = 0.451). Similarly, no significant association was identified between ANC service scores and the evaluated sociodemographic or pregnancy-related variables. Overall, these findings suggest that, within this study population, ANC service quality scores were not significantly influenced by the measured participant characteristics.

Discussion

In this study, the quality and utilization of antenatal care (ANC) services provided to pregnant women registered at training family health centers were evaluated. The findings indicate that ANC services were generally delivered at a high level of quality, with the majority of participants who completed four follow-up visits achieving high ANC service scores. Importantly, no statistically significant association was observed between ANC service scores and sociodemographic or pregnancy-related characteristics, suggesting that ANC services were delivered consistently across the evaluated sociodemographic and pregnancy-related groups.
The mean ANC service score observed in this study (5.62 ± 0.71) is consistent with findings from previous studies conducted in Türkiye. Gürsoy Demir reported similarly high ANC quality scores among pregnant women attending outpatient clinics, while Türkmen and Omaç et al. found that a large proportion of participants received adequate or good-quality ANC services.^8,15,18 These findings suggest that the implementation of standardized antenatal follow-up protocols in primary care settings may contribute to the consistent delivery of essential ANC components.
In the present study, maternal age and educational level were not associated with ANC service quality. These results are in line with previous studies conducted after the widespread implementation of the family medicine model in Türkiye, which reported no significant relationship between age or education level and ANC scores.^8,9,11 Earlier studies conducted before the establishment of the family medicine system reported lower ANC quality among older or less educated women.^10,12 This difference may indicate that the family medicine model has contributed to reducing disparities in access to and quality of antenatal care, in line with international recommendations emphasizing standardized antenatal follow-up for all pregnant women.¹⁹
High rates of tetanus immunization and routine ANC service component delivery were observed in the relevant analysis subgroups defined according to data completeness and source. The tetanus immunization rate in this study was comparable to national data and previous regional studies.^2,9,14,16 Similarly, the high rates of iron supplementation and other routinely recorded ANC practices reflect effective implementation of national antenatal care guidelines in primary care settings.^2,5,17 However, the presence of vaccine refusal among a proportion of participants highlights the ongoing need for effective counseling strategies to address vaccine hesitancy during pregnancy.
Counseling services were received by approximately four-fifths of the interviewed participants, with nutrition being the most frequently addressed topic. This finding is consistent with previous studies reporting a greater emphasis on nutritional counseling during pregnancy.^8,12 In contrast, counseling related to breastfeeding and family planning was reported at notably lower rates. Similar deficiencies have been documented in studies conducted in family health centers in Türkiye, indicating that counseling components of antenatal care are often delivered less consistently than clinical and preventive interventions.¹³ Strengthening counseling services in line with national antenatal care guidelines may contribute to improving the quality and comprehensiveness of antenatal care provided in primary care settings.^7,19
No significant association was found between ANC service scores and factors such as smoking exposure, pregnancy intention, number of pregnancies, or high-risk pregnancy status. These findings suggest that ANC services were provided independently of individual risk profiles, which may reflect adherence to standardized care protocols in family health centers. While this uniform approach supports equitable service delivery, it also underscores the importance of individualized counseling and risk-based interventions within routine ANC follow-up. Overall, the findings indicate that training family health centers provides high-quality antenatal care services.
The absence of significant disparities across sociodemographic groups supports the effectiveness of the primary care-based family medicine model in delivering standardized ANC services. Nevertheless, gaps identified in counseling practices highlight areas for improvement.

Limitations

This study has several limitations that should be considered when interpreting the findings. First, data not available in electronic medical records were collected through telephone interviews, which may have limited the depth and detail of the information obtained compared with face-to-face interviews. Second, the study was conducted in two training family health centers affiliated with a single teaching and research hospital, which may limit the generalizability of the findings to other primary care settings.
In addition, the descriptive study design does not allow for causal inferences regarding factors associated with antenatal care service quality. Finally, the assessment of antenatal care quality was based on selected service components recorded in follow-up data, and qualitative aspects of care, such as patient satisfaction and perceived quality, were not evaluated.

Conclusion

This study showed that antenatal care services provided to pregnant women registered at training family health centers were generally of high quality. Most participants who completed four antenatal follow-up visits received essential components of antenatal care, including tetanus immunization, routine clinical assessments, and iron supplementation. Antenatal care service quality was not significantly associated with sociodemographic or pregnancy-related characteristics, suggesting a relatively equitable pattern of service delivery within the primary care setting. However, some gaps were identified in counseling services, particularly regarding breastfeeding and family planning. Strengthening counseling components in line with national antenatal care guidelines may help improve the quality and comprehensiveness of antenatal care services in primary care.

Declarations

Abbreviations

ANC: antenatal care
IQR: interquartile range
SPSS: statistical package for the social sciences
STROBE: strengthening the reporting of observational studies in epidemiology

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About This Article

Received:

March 28, 2026

Accepted:

April 24, 2026

Published Online:

April 29, 2026