Why Keeping Your ANC Appointments Matters
What is the evidence that attending all recommended ANC contacts improves pregnancy outcomes?
18/08/2026
What the Evidence Shows
Rwanda's Demographic and Health Survey (DHS) 2019–20 shows that among women who gave birth in the five years before the survey, 98% attended at least one ANC visit — a remarkable achievement. However, only approximately 69% attended the minimum four recommended contacts. The difference between those who attended all four contacts and those who attended fewer was associated with significant differences in delivery outcomes, skilled attendance, and newborn survival.
WHO's systematic review of evidence underlying the 2016 ANC guidelines found that women who received eight or more ANC contacts had significantly better outcomes across multiple measures — including lower rates of preterm birth, lower rates of low birth weight, lower rates of perinatal mortality, and higher rates of facility delivery — compared to women who received fewer contacts.
What You Miss When You Miss a Visit
Each missed ANC visit is a missed opportunity to detect a developing problem. Blood pressure is checked at every visit — missing any contact could mean missing the visit at which your blood pressure first reached concerning levels, delaying the detection and management of preeclampsia.
Iron and IPTp-SP supplements are given at each visit — missing contacts means missed supplement doses and incomplete malaria prevention. Counselling on danger signs, nutrition, and birth preparedness is delivered progressively across visits — missing contacts leaves gaps in your knowledge that could affect your ability to recognise and respond to emergencies.
The Role of Attendance in Facility Delivery
Rwanda has achieved a national facility delivery rate of over 94% — a remarkable and life-saving achievement driven by a deliberate policy of encouraging ANC attendance and planned facility delivery. Rwanda's success in reducing maternal mortality from over 1,000 deaths per 100,000 live births in 2000 to below 250 per 100,000 live births by 2020 is in part attributable to this achievement.
Women who attend ANC regularly are significantly more likely to plan and achieve a facility delivery because ANC discussions explicitly address birth preparedness, transport planning, and the specific health facility at which the woman will deliver. ANC builds the relationship between the pregnant woman and the health system that makes a facility delivery feel accessible rather than distant.
Overcoming Barriers to Attendance
The most common barriers to ANC attendance include distance to the facility, cost, transport challenges, lack of a support person to accompany the woman, work responsibilities, and — for subsequent pregnancies — the competing demands of caring for other children. Recognising these barriers is the first step to addressing them.
Your Community Health Worker (Umujyanama w'ubuzima) can help you plan for each ANC visit in advance — identifying transport, arranging a support person, and reminding you of the date. Mutuelle de Santé covers ANC at public health facilities, eliminating the cost barrier. If you are struggling to attend, talk to your CHW or your health provider — they can help problem-solve specific barriers.
After Missing an Appointment — What to Do
If you have missed a scheduled ANC appointment, go to your health facility as soon as possible — do not wait for the next scheduled date. Attending even a few days or a couple of weeks late is far better than missing the contact entirely. Tell your provider honestly which visits you have attended and which you missed — they need accurate information to provide appropriate care.
You will not be judged or scolded for missing an appointment. Your provider's concern is your health and your baby's health — not adherence to a schedule for its own sake. They will assess your current status, provide any interventions that were missed, and schedule your next visit according to your actual gestational age.
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