Considerations for Implementing Group‐Level Prenatal Health Interventions in Low‐Resource Communities: Lessons Learned From Haiti

Abstract

Haiti's high maternal and infant mortality rates evidence an urgent need for implementation of evidence-based strategies. A potential cost-effective strategy to mitigate high maternal and infant mortality rates is group prenatal care, an innovative model that combines antenatal clinical assessment with pregnancy education. Despite research demonstrating the effectiveness of this model in high-resource settings, less is known about the challenges of implementing it in low-resource settings. The purpose of this article is to provide recommendations for overcoming challenges of implementing group prenatal care in low-resources communities globally. Challenges addressed include language, literacy, space, cultural appropriateness of intervention content, and sociopolitical climate. Using examples from work conducted in Haiti, this information can be used to assist practitioners and researchers with overcoming challenges of implementing models of group care in international low-resource communities.

The Mexican Experience Adapting CenteringPregnancy: Lessons Learned in a Publicly Funded Health Care System Serving Vulnerable Women

“…In contrast with our findings, literature in low‐income settings has focused on culture change and implementing group antenatal care models in the context of foreign health care providers leading groups . In Mexico, the same people who normally work in the facilities led all group antenatal care sessions; the Mexican research team was present during sessions but did not facilitate them.…”

“…The decision was made to hold sessions in a diverse set of conveniently accessible, shared public locations. Running groups outside clinics posed several challenges, including high temperatures and concerns about women's comfort, as well as confidentiality …”

“…Our experience, however, did not face some challenges described in other low‐ and middle‐income country settings. For example, we did not need to translate materials to a local language or use translators during group sessions, which can negatively affect group dynamics . High rates of illiteracy among women and an adverse sociopolitical context, noted in previous literature, were not part of our initial experience of adaptation and implementation.…”

“…In Iran, a randomized controlled trial found significantly higher birth weight in newborns of women in group antenatal care compared with individual care . Currently, CenteringPregnancy is being implemented or adapted in Africa, Australia, Asia, and Haiti …”

Increasing postpartum family planning uptake through group antenatal care: a longitudinal prospective cohort design

“…While little research exists on group ANC in low- and middle-income countries, several studies have shown the feasibility of delivering group ANC in these settings [26, 27]. Challenges to implementing group ANC in a low resource setting (Haiti) have been described and include space, literacy, language, and cultural appropriateness of content [31]. While this is not the focus of this article, the description of the process of adaptation and implementation are described elsewhere [26, 28].…”