Quality of antenatal care and pregnancy outcomes in central India: Implications for nursing and maternal health policy

Background: Antenatal care (ANC) is globally recognized as a critical intervention for reducing maternal and neonatal morbidity and mortality. However, in many low- and middle-income countries, including India, disparities persist between coverage and content of ANC services. While access to care has improved, the quality of interactions, provider competence, and respectful communication remain inconsistent. This study aimed to evaluate the quality of ANC and its relationship with pregnancy outcomes, with a focus on the role of nursing competence and communication in shaping care experiences and maternal–neonatal outcomes in Central India. Methods: A quantitative cross-sectional study was conducted from July 2023 to January 2024 in six government maternity facilities across Indore and Dewas districts, Madhya Pradesh, India. The study included 400 participants (100 nurses and 300 pregnant women) selected through multistage sampling. Data were collected using four validated tools: the Nurse Competence Scale, Communication Behavior Scale, ANC Quality Checklist, and Outcome Record Form. Data were analyzed using IBM SPSS v26, employing descriptive statistics, Pearson’s correlation, multiple linear regression, and logistic regression to identify predictors of ANC quality and birth outcomes. Ethical approval was obtained from the Malwanchal University Institutional Ethics Committee (Ref: MU/IEC/OBG/2023/117). Results: The mean ANC quality score was 4.22 ± 0.41 on a 5-point scale, and mean maternal satisfaction was 8.6 ± 1.1 on a 10-point scale. Nursing competence and communication behavior were strong predictors of ANC quality (? = .41 and .32, respectively; p