Vietnam has high numbers of maternal and infant mortality and morbidity. Each year, 1,500 women die and 45,000 others become disabled as a result of pregnancy and childbirth complications.1 There were 37,700 neonatal deaths in Vietnam in 1999.2 The maternal mortality rate is 165 per 100,000 live births3 and the infant mortality rate is around 30 per 1,000 live births.4,5

Antenatal care (ANC) has been proven to be effective in preventing pregnancy adverse outcomes.6 For ANC to be effective, women should have enough visits at appropriate times, with sufficient ANC content. The World Health Organization (WHO) recommends four visits at the 4th, 6th or 7th, 8th, and 9th month for women in developing countries.7 The Vietnamese government recommends three visits, one during each trimester.8 WHO recommends three basic components of ANC content: (1) biomedical assessment based on medical history, physical examination, and laboratory tests; (2) health promotion; and (3) care provision.7

To measure ANC adequacy, many indicators and indices have been developed in the world. Single indicators are any ANC, number of ANC visits, and duration of pregnancy at entry to ANC. Complex indices that combine number of ANC visits and duration of pregnancy at first visit are the Kessner index,9 the Graduated Index of Prenatal Care Utilization,10 the Adequacy of Prenatal Care Utilization Index,11 and the Prenatal Care Evidence-Based Index.12 These indices are suitable for developed countries because of the high cut-off points. There has been a modified index in the Philippines with the lower cut-off point of five visits and initial visit within the first three months,13 but this index might not be suitable for other less developed countries like Vietnam.

In contrast to the numerous methods of measuring ANC utilization, there have been very few indicators or indices available to measure ANC content. Some studies used single indicators such as receiving certain services,14,15 receiving all or part of procedures or information,16,17 or average number of services delivered.18,19

Studies on overall ANC adequacy that combine ANC utilization and ANC content are even rarer. One study identified used a scoring system, in which weighted scores based on expert opinion were given to items of ANC utilization and content.20 However, each country or region may weight the importance of each item differently at different times; therefore, this method can only be applied in certain areas at a certain time.

ANC in Vietnam is low. Seventy-one percent of women had any ANC in 199721 and 87% in 2002.22 Other studies on local scale also show the low level of ANC.23–25 Information on ANC adequacy in Vietnam is limited, not only because of the small number of studies, but also because of the limited information that these studies provide. These studies use only single indicators; none of them use any index to provide comprehensive information on overall ANC adequacy.

Furthermore, these studies use different cut-off points. The cut-off points for duration of pregnancy at first visit were six months21,22 and 20 weeks,23 which do not comply with the Vietnamese government guideline nor with WHO guidelines.7 The cut-off point for the number of visits varies between three24 and four visits.21,22

The objectives of this study were to propose and apply a set of indicators and indices to measure ANC adequacy levels in the three provinces and to select the most suitable index to measure ANC adequacy in this setting, using the data collected by the Vietnam Australia Primary Health Care Project.

To our knowledge, this is the first study in Vietnam that uses the indices to provide comprehensive information on ANC adequacy levels. This information will be useful for future interventions to improve ANC in the three provinces and in other similar provinces of Vietnam. The selected index can be used in other studies in Vietnam and similar developing countries. It also can be modified easily to suit each specific study.

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