Measuring antenatal care use in Europe: is the content and timing of care in pregnancy tool applicable?

Objectives: Measuring of antenatal care utilisation is important from a public health perspective. The Content and Timing of care in Pregnancy tool (CTP) focuses on the care process and includes aspects on quality of care. The aim of the study is to gain insight in the applicability of the CTP tool across Europe. Methods: National guidelines for routine antenatal care were examined, analysing the degree to which the four items in the CTP tool were included in these guidelines. Results: From the 30 countries, 22 had a national guideline for routine antenatal care. The CTP tool is applicable in over 60% of the European countries with a national guideline. Conclusions: The CTP tool can be used to measure antenatal care delivery in Europe. The tool is useful to evaluate the care process, focusing on rates of interventions as the closest approximation to the delivery of health care, with a focus on content of visits rather than simply the number of visits. Together with indicators measuring structure and outcome of health care, conclusions about the quality of care can be made.