The number of pregnant women in developing countries receiving antenatal care during pregnancy has increased significantly since 1990, signalling that an untapped opportunity exists to reach poor women with a whole package of life-saving health services, according to a joint report issued by UNICEF and the World Health Organization.

The number of women receiving antenatal care has increased by 20 per cent since 1990, with the greatest progress in Asia (31 per cent) and the least improvement in sub-Saharan Africa (4 per cent).

"The advantages of receiving regular antenatal care cannot be stressed enough," said Carol Bellamy, executive director of UNICEF. "If a woman comes for antenatal care early in her pregnancy, there is time for early diagnosis and treatment of infections in the mother, and an opportunity to prevent low birth weight and other conditions in the newborn. These findings have enormous significance for maternal health and child survival."

The study highlights nations that have begun to see antenatal care visits as a unique opportunity to provide the pregnant woman with a vaccination to prevent tetanus, an insecticide-treated bednet to prevent malaria, screenings for anaemia, and enrolling women in Prevention of Mother to Child Transmission of HIV, counselling for a safe delivery - all factors that help ensure that the mother remains healthy through childbirth and gives her child the best start in life.

Antenatal care also increases the likelihood of a skilled attendant being present at the birth. A skilled attendant is a doctor, midwife, nurse, or other health care provider with equivalent skills, who can detect and manage complications at birth. This can often mean the difference between life and death for both mother and baby.

"The most dangerous time for a pregnant woman is the critical period around labour and delivery, which is when most women die," said Joy Phumaphi, assistant director-general for Family and Community Health at WHO. "Giving care and information during pregnancy can help reduce the number of women who die giving birth."

More than half of women in the developing world are getting at least four antenatal visits during their pregnancy, which is in line with the WHO recommendation that antenatal care for normal pregnancies should be a minimum of four visits.

Notable exceptions, however, include Bangladesh, Ethiopia, Morocco, Nepal and Yemen, all of which have relatively high percentages of women who have only one antenatal care visit. South Asia, overall, had the lowest levels of antenatal care with only 50 per cent of women getting even one visit.

The study finds that antenatal care is heavily influenced by such factors as wealth and education. In poor households, women are far less likely to use antenatal care than women in well-off households.

And the report notes that women with secondary schooling are two to three times more likely to have antenatal care than women with no education.

"This demonstrates, yet again, the undeniably powerful link between education and improving the lives of women and their children," Bellamy said.

Antenatal health care visits can be a critical opportunity for women to get access to other healthcare services, and the report concludes that this opportunity is not being maximized in most instances.

"Improving antenatal care is vital to achieving several of the Millennium Development Goals," says WHO's Phumaphi. "Reducing child mortality, malaria and TB prevalence and mortality, and reducing HIV transmission, depend to a large extent on reaching women during pregnancy with interventions we know work."

The authors of the report point out that greater efforts need to be directed toward: improving women's nutritional status and preventing and treating infections (e.g. malaria, sexually transmitted infections, and tetanus); providing information and services for HIV prevention and care, in particular for the prevention of HIV transmission from mother to child; supplying information on birth spacing, important to improve infant health and survival; informing women and families about danger signs and symptoms and potential risks of labour and delivery.