Exploring perceptions of group antenatal Care in Urban India: results of a feasibility study

Abstract

BackgroundMaking high-quality health care available to all women during pregnancy is a critical strategy for improving perinatal outcomes for mothers and babies everywhere. Research from high-income countries suggests that antenatal care delivered in a group may be an effective way to improve the provision, experiences, and outcomes of care for pregnant women and newborns. A number of researchers and programmers are adapting group antenatal care (ANC) models for use in low- and middle-income countries (LMIC), but the evidence base from these settings is limited and no studies to date have assessed the feasibility and acceptability of group ANC in India.MethodsWe adapted a “generic” model of group antenatal care developed through a systematic scoping review of the existing evidence on group ANC in LMICs for use in an urban setting in India, after looking at local, national and global guidelines to tailor the model content. We demonstrated one session of the model to physicians, auxiliary nurse midwives, administrators, pregnant women, and support persons from three different types of health facilities in Vadodara, India and used qualitative methods to gather and analyze feedback from participants on the perceived feasibility and acceptability of the model.ResultsProviders and recipients of care expressed support and enthusiasm for the model and offered specific feedback on its components: physical assessment, active learning, and social support. In general, after witnessing a demonstration of the model, both groups of participants—providers and beneficiaries—saw group ANC as a vehicle for delivering more comprehensive ANC services, improving experiences of care, empowering women to become more active partners and participants in their care, and potentially addressing some current health system challenges.ConclusionThis study suggests that introducing group ANC would be feasible and acceptable to stakeholders from various care delivery settings, including an urban primary health clinic, a community-based mother and child health center, and a private hospital, in urban India.

The power of peers: an effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

“…Providers noted that groups made delivering ANC services easier, led to improved acceptance of ANC, facility-based delivery services, and family planning methods, and provided a space for women’s empowerment and social support. Provider perspectives are consistent with qualitative data from group ANC piloted in India [26]. Providers also noted the importance of home visits as part of the intervention and the value of collaboration between the nurse midwives and the CHWs.…”

Systematic review of barriers to, and facilitators of, the provision of high‐quality midwifery services in India

“…Of the studies providing qualitative data, five were interview studies 15,[41][42][43][44] and two 45,46 were interview studies with the addition of focus groups. Table 2 presents the methodological quality of the qualitative studies.…”

“…In 13 studies, participants were health service providers. Four studies 38,[43][44][45] included both women and health service providers. The most frequently included cadre of health workers was ANMs (n = 7 studies).…”

“…Four studies included community health workers described as Anganwadi workers, 18 lady health visitors, 9,46 and social health activists. 45 Six studies 28,[42][43][44][45][46] included a range of other health workers such as doctors, administrators, laboratory staff, and pharmacists.…”

“Taking Care of Your Pregnancy”: A Mixed-Methods Study of Group Antenatal Care in Kakamega County, Kenya

“…Health care providers also noted an improvement in their relationships with women. Studies in LMICs con rm this result: women valued the peer support and improved relationships with health providers and the support that came from these bonds [25][26][27]36,37]. This nding was perhaps due to the emphasis of our GANC model on fostering social bonds by linking women with other pregnant women at similar gestational ages, pairing individual women, and using interactive learning techniques to help women discuss problems and challenges.…”