{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T13:31:49Z","timestamp":1768829509137,"version":"3.49.0"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T00:00:00Z","timestamp":1706832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008309","name":"Johns Hopkins Bloomberg School of Public Health","doi-asserted-by":"publisher","award":["1605030010"],"award-info":[{"award-number":["1605030010"]}],"id":[{"id":"10.13039\/100008309","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Antenatal care is an essential component of primary healthcare, providing opportunities to screen, prevent, and treat morbidity to preserve the health of mothers and offspring. The World Health Organization now recommends a minimum of eight antenatal care contacts, instead of four, which is challenging in countries exposed to political violence and structural disparities in access to social, economic and healthcare resources as exist in Palestine. This study examines the compliance of the recommend standard of antenatal care in Palestine.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We analyzed data from the UNICEF\u2019s Palestinian Multiple Indicator Cluster Survey (MICS) 2019\u20132020. The eligible sample consisted of 2,028 women, 15\u201349 years of age, living in Palestine, on whom data were available on reported antenatal care services received during the most recent pregnancy within the last two years. Outcome variables of interest were the reported frequencies of antenatal care visits, gestational timing of 1<jats:sup>st<\/jats:sup> visit, and services received. Potential risk factors were assessed in women attending less than eight versus eight or more antenatal contacts, as recommended by WHO, by estimating prevalence ratios with 95% Confidence Intervals.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, 28% of women did not meet the WHO\u2019s recommendation of eight or more antenatal contacts, varying from 18% in Central West Bank to 33% in South West Bank across the four areas of Palestine (North, Central, and South West Bank and Gaza Strip). Twelve percent of women reported having had no antenatal contacts in the 1<jats:sup>st<\/jats:sup> trimester, and these women were two- to three-folds more unlikely to meet WHO recommendation of antenatal contacts than mothers who initiated the antenatal contact in the 1<jats:sup>st<\/jats:sup> trimester. Women who had less than eight antenatal contacts were generally poorer, higher in parity, lived in North and South West Bank, sought ANC from either doctor or nurse\/midwife only, and initiated antenatal contact in 2<jats:sup>nd<\/jats:sup>-to-3<jats:sup>rd<\/jats:sup> trimesters.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>There were considerable socioeconomic and geographic inequalities in the prevalence of not meeting WHO recommended number of antenatal contacts in Palestine, offering the opportunity to inform, improve and continuously reassess coverage of antenatal care.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0297956","type":"journal-article","created":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T18:28:25Z","timestamp":1706898505000},"page":"e0297956","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Understanding coverage of antenatal care in Palestine: Cross-sectional analysis of Palestinian Multiple Indicator Cluster Survey, 2019\u20132020"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6544-1622","authenticated-orcid":true,"given":"Masako","family":"Horino","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salwa","family":"Massad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saifuddin","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Abu Khalid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yehia","family":"Abed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,2,2]]},"reference":[{"key":"pone.0297956.ref001","unstructured":"United Nations. SDG Indicators Mandatory Repository. https:\/\/unstats.un.org\/sdgs\/metadata\/?Text=&Goal=3&Target=3.8. 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A WHO-UNICEF-Lancet Commission","volume":"395","author":"H Clark","year":"2020","journal-title":"Lancet"},{"key":"pone.0297956.ref005","doi-asserted-by":"crossref","first-page":"e977","DOI":"10.1016\/S2214-109X(17)30325-X","article-title":"Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013","volume":"5","author":"AB Moller","year":"2017","journal-title":"Lancet Glob Health"},{"key":"pone.0297956.ref006","author":"WHO","year":"2016"},{"issue":"1","key":"pone.0297956.ref007","doi-asserted-by":"crossref","first-page":"010502","DOI":"10.7189\/jogh.10.010502","article-title":"Timing and number of antenatal care visits in low and middle-income countries: Analysis in the Countdown to 2030 priority countries","volume":"10","author":"SS Jiwani","year":"2020","journal-title":"J Glob Health"},{"key":"pone.0297956.ref008","doi-asserted-by":"crossref","first-page":"100727","DOI":"10.1016\/j.ssmph.2021.100727","article-title":"Primary healthcare and child and maternal health in the Middle East and North Africa (MENA): A retrospective analysis of 29 national survey data from 13 countries","volume":"13","author":"Z Nikoloski","year":"2021","journal-title":"SSM Popul Health"},{"issue":"1","key":"pone.0297956.ref009","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1186\/s12978-018-0542-3","article-title":"Determinants of antenatal care attendance among women residing in highly disadvantaged communities in northern Jordan: a cross-sectional study","volume":"15","author":"HH Hijazi","year":"2018","journal-title":"Reprod Health"},{"issue":"5","key":"pone.0297956.ref010","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1053\/j.semperi.2019.03.020","article-title":"Trends of antenatal care during pregnancy in low- and middle-income countries: Findings from the global network maternal and newborn health registry","volume":"43","author":"SS Tikmani","year":"2019","journal-title":"Semin Perinatol"},{"key":"pone.0297956.ref011","unstructured":"Palestine Central Bureau of Statistics. 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Eklund","year":"2010"},{"key":"pone.0297956.ref033","unstructured":"United Nations Office for the Coordination of Humanitarian Affairs. Longstanding access restrictions continue to undermine the living conditions of West Bank Palestinians. https:\/\/www.ochaPalestine.org\/content\/longstanding-access-restrictions-continue-undermine-living-conditions-west-bank\u2014palestinians. Updated on June 2, 2020. Accessed on October 28, 2021."},{"issue":"3","key":"pone.0297956.ref034","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/13623699.2019.1666520","article-title":"Occupation, settlement, and the social determinants of health for West Bank Palestinians","volume":"35","author":"K Fahoum","year":"2019","journal-title":"Med Confl Surviv"},{"key":"pone.0297956.ref035","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/tran.12045","article-title":"Gated\/gating community: the settlement complex in the West Bank","volume":"39","author":"A. 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