Antenatal Care and Perinatal Mortality in Low- and Middle-Income Countries: Insights for Maternal and Newborn Health System.

Objective: To examine differences in perinatal mortality among women with and without antenatal care (ANC) in low- and middle-income countries (LMICs) and identify associated factors. Patients and Methods: This study analyzed demographic and health survey data collected between June 15, 2015, and May 31, 2024, from 41 LMICs, comprising 494,259 weighted observations. Mixed-effects logistic regression was used to account for the hierarchical data structure and identify factors associated with perinatal mortality among women with and without ANC, with Results: The prevalence of perinatal mortality among ANC users and non-ANC users was found to be 40.1 per 1000 total births (95% CI, 39.58-40.72) and 51.9 per 1000 total births (95% CI, 49.73-53.99), respectively. Among ANC users, women with 8 or more ANC contacts had a markedly lower prevalence (26.4 per 1000 births; 95% CI, 25.29-27.52). Preceding birth interval, a history of terminated pregnancy, mode of delivery, tetanus vaccine, wealth index, twin birth, type of cooking fuel, and subregions of world countries were significantly associated with perinatal mortality in both groups. Besides the type of toilet facility, women's access to decision making, mothers' education, and place of delivery were factors significantly associated with perinatal mortality in ANC user women. Conclusion: Perinatal mortality was substantially higher among women without ANC, whereas women with 8 or more ANC contacts had approximately half the risk, emphasizing the urgent need to expand access to World Health Organization-recommended ANC and address key factors associated with perinatal mortality in LMICs.