Prenatal care and child growth and schooling in four low- and medium-income countries
Xiaoying Liu1, Jere R Behrman1, Aryeh D Stein2,3
1Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Insights
Prenatal care visits in low-income countries did not impact birth weight but were linked to better child growth and higher educational attainment. These findings highlight the long-term benefits of early healthcare for human capital development.
Area of Science:
- Global Health
- Developmental Pediatrics
- Human Capital Development
Background:
- Effectiveness of prenatal care (PNC) for improving birth and child outcomes in low-income countries (LICs) is debated.
- Existing evidence often comes from high-income countries and focuses on early-life outcomes.
- This study examines PNC associations with birth weight, child growth, and educational attainment in four LICs.
Purpose of the Study:
- To investigate the association between prenatal care utilization and long-term child outcomes.
- To assess the impact of PNC on birth weight, height-for-age at 24 months, and attained schooling.
- To provide evidence on the relevance of PNC for human capital development in low- and middle-income countries.
Main Methods:
- Pooled data from prospective birth-cohort studies in Brazil, Guatemala, Philippines, and South Africa.
- Developed a prenatal care utilization index based on visit number and timing.
- Analyzed associations between the index and birth weight, height-for-age z-scores, and attained schooling grades.
Main Results:
- Prenatal care utilization was not significantly associated with birth weight across pooled data.
- Each unit increase in the PNC utilization index correlated with a higher height-for-age z-score at 24 months (0.09 increase).
- Increased PNC utilization was associated with higher attained schooling grades (0.26 increase).
Conclusions:
- Prenatal care visits are not linked to birth weight but are associated with improved later-life outcomes.
- PNC utilization is positively related to better child growth (height-for-age) and educational attainment.
- Findings underscore the importance of PNC for developing human capital throughout the lifecycle in resource-limited settings.
Background:
The effectiveness of prenatal care for improving birth and subsequent child outcomes in low-income countries remains controversial, with much of the evidence to date coming from high-income countries and focused on early-life outcomes. We examined associations between prenatal care visits and birth weight, height-for-age at 24 months and attained schooling in four low- and middle-income countries.
Methods:
We pooled data from prospective birth-cohort studies from Brazil, Guatemala, Philippines and South Africa. We created a prenatal care utilization index based on the number and timing of prenatal visits. Associations were examined between this index and birth weight, height-for-age at 24 months, and highest attained schooling grade until adulthood.
Results:
Among 7203 individuals in the analysis, 68.9% (Philippines) to 96.7% (South Africa) had at least one prenatal care visit, with most having at least four visits. Over 40% of Brazilians and Guatemalans had their first prenatal visit in the first trimester, but fewer Filipinos (13.9%) and South Africans (19.8%) did so. Prenatal care utilization was not significantly associated with birth weight (p>0.05 in pooled data). Each unit increase in the prenatal care utilization index was associated with 0.09 (95% CI 0.04 to 0.15) higher height-for-age z-score at 24 months and with 0.26 (95% CI 0.17 to 0.35) higher schooling grades attained. Although there was some heterogeneity and greater imprecision across sites, the results were qualitatively similar among the four different populations.
Conclusions:
While not related to birth weight, prenatal care utilization was associated with important outcomes later in life, specifically higher height-for-age at 24 months and higher attained school grades. These results suggest the relevance of prenatal care visits for human capital outcomes important over the lifecycle.
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