ArticlePloS one2025
Association between antenatal care visits and under-five mortality: An Analysis of the Pakistan demographic and health surveys.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Direct and Indirect Effects of Adolescent Motherhood on Under-Five Mortality in Pakistan: Evidence From a Nationally Representative Survey.American journal of human biology : the official journal of the Human Biology Council · 2026Article
- Burden of diarrheal diseases among children under five in East Africa, 2000-2023: insights from the global burden of disease 2023 study.BMC infectious diseases · 2026Article
- Consanguineous marriages and low birth weight mediating role of antenatal care visits.Scientific reports · 2025Article
- The nexus between healthcare provider distribution and neonatal mortality based on the context of maternal and child healthcare services in Pakistan.Journal of health, population, and nutrition · 2025Article
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6 authors.
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Abstract
backgroundPakistan has the third highest under-five mortality rate globally and minimal progress in reducing it, obstructing its achievement of Sustainable Development Goals (SDGs) 3.2 targets. Despite a decline, Pakistan remains one of the top ten contributors to worldwide under-five mortality. Proper antenatal care (ANC) is vital for improving maternal and child health outcomes. This study aims to assess the association between ANC visits and under-five mortality. Moreover, this study also measures the association between the timing of ANC visits and under-five mortality.
methodsA difference-in-difference (DID) study design with propensity score matching (PSM) was employed to investigate the contributing impact of ANC on the estimation of under-five mortality rates. Statistics from two datasets, 2012 and 2018, of Pakistan demographic and health surveys (PDHS) have been utilized for analyses. This research sample consists of 15698 women aged 15-49 who attended ANC visits at varying times before childbirth.
resultsThis study has reported 730 cases of under-five mortality. 98% involved Women who had less than eight or more ANC visits, whereas 2% of under-five mortality cases occurred among those women who had eight or more ANC visits. Overall, our results showed that women who had 1-3 ANC visits reduced the likelihood of under-five mortality in Pakistan by 36% (CI=0.459-0.909, P-value 0.012), the women who had 4-7 ANC visits decreased the likelihood of under-five mortality by 45% (CI=0.364-0.843, P-value 0.006). Moreover, the females with eight or more ANC visits also reduced the likelihood of under-five mortality by 98% (CI=0.512-1.896, P-value 0.966).
conclusionsPolicies and programs focusing more on ANC visits should be implemented to reduce under-five mortality rates significantly. By emphasizing timely and frequent ANC visits, these insights support the development of targeted interventions that can significantly improve child survival rates and support the achievement of SDG targets. Moreover, based on our DID analysis, the implementation of the free maternal and child healthcare (MCH) policy in Pakistan has led to a significant increase in ANC utilization and a consistent reduction in the under-five mortality rates.
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