Community-Based Antenatal Care Quality Assessment: Evidence from Lady Health Workers and Midwives in in Tehsil Kharian and Kunjah, District Gujrat, Pakistan

Abstract

Background: Antenatal care (ANC) is essential for improving maternal and neonatal health outcomes through early detection and management of pregnancy-related complications. Despite progress, Pakistan continues to face a high maternal mortality ratio of approximately 155 per 100,000 live births, with preventable causes such as eclampsia, infections, and hemorrhage contributing significantly. Frontline providers, including Lady Health Workers (LHWs) and Community Midwives (CMWs), play a pivotal role in delivering quality ANC services at the community level. This study aimed to assess the quality of ANC services provided by LHWs and CMWs in Tehsil Kharian, District Gujrat. Methods: A cross-sectional study was conducted among 144 participants, including LHWs and CMWs. Data were collected using a structured questionnaire through systematic random sampling. Statistical analysis was performed using SPSS version 25. Descriptive statistics (frequencies and percentages) and inferential analysis using the Chi-square test were applied to determine associations between variables. Results: Of the 144 participants, 110 (76.4%) were LHWs and 34 (23.6%) were CMWs. Only 29% of LHWs and 32.3% of CMWs had received reproductive health training. Approximately 60% reported inadequate facilities, and 56.6% were unable to provide standard ANC services. Supervised health workers demonstrated significantly better skills and performed more ANC procedures compared to unsupervised workers (p = 0.03). No statistically significant association was found between service quality and demographic variables (p > 0.05). Conclusion: Significant gaps exist in training, supervision, and resource availability among LHWs and CMWs. Strengthening capacity-building programs, supportive supervision, and infrastructure is essential to improve the quality of ANC services and maternal health outcomes.