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

Lori, Jody R.; Chuey, Meagan; Munro‐Kramer, Michelle L.; Ofosu-Darkwah, Henrietta; Adanu, Richard

doi:10.1186/s12978-018-0644-y

Cited by 34 publications

(66 citation statements)

References 31 publications

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“…We found no quantitative evidence that GANC led to changes in adoption of other behaviors, for example in use of family planning and facility delivery, though this has been documented elsewhere in the literature [21][22][23][24]. We hypothesize that non-use of family planning in our sample may be due to a low perceived risk of pregnancy before a return of menses, as a systematic review found [38].…”

Section: Discussioncontrasting

confidence: 54%

“…In HICs, GANC has been associated with higher satisfaction with care, increased social support, and enhanced relationships with providers [16][17][18][19][20]. Group care models have been introduced in several LMICs and demonstrated positive associations in knowledge of danger signs and adoption of healthy behaviors, such as birth preparedness, delivery in a health facility, breastfeeding initiation, and uptake of family planning [15,[21][22][23][24]. Other studies [25][26][27] reported the establishment of social bonds between women participating in GANC and improved relationships between women and health providers.…”

Section: Introductionmentioning

confidence: 99%

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

Somji¹,

Ramsey²,

Dryer³

et al. 2020

Preprint

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Abstract Background: Traditional antenatal care (ANC) models often do not meet women’s needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. There are few studies that show associations between GANC and various outcomes. Methods: We used mixed methods to evaluate a contextualized GANC model (Lea Mimba Pregnancy Clubs) and to understand implementation experiences at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1,652 women who were assigned to 162 GANC cohorts to assess ANC retention. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes and used time diaries to assess wait times. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders.Results: GANC was associated with enhanced social support, with some evidence for improved knowledge, adoption of healthy behaviors, enhanced self-efficacy, and improved experience of care. Quantitatively, we found strong associations with knowledge of danger signs, women who shared their feelings with other women, knowledge and competence of health workers, respect shown by ANC providers, overall quality of care, and birth preparations. No changes were seen in knowledge of positive behaviors, empowerment, several aspects of the experience of care, ANC retention, early ANC, and other healthy behaviors. Qualitatively, women and stakeholders noted improvements in interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely, and strengthened social networks and enhanced social cohesion among women. Both wait times and counseling times increased in GANC compared to traditional ANC.Conclusions: This is one of the few mixed-methods studies evaluating GANC and offers new measures for experience of care, empowerment, and adoption of healthy behaviors. While more research is required, GANC holds promise for enhancing women’s experiences during pregnancy. Modifications are needed for sustainability and scalability.

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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

Somji¹,

Ramsey²,

Dryer³

et al. 2020

Preprint

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show abstract

“…23 Several large studies of group care are ongoing in Ghana, Kenya, Nigeria, and Rwanda with large samples, and three of these have already reported positive outcomes, including more PNC attendance and more facility births. 21,[24][25][26][27] This growing body of evidence will allow policy makers to determine whether the group care model should become the standard of care to provide higher quality care and a positive pregnancy experience for women in low-resource countries in Africa and globally.…”

Section: Discussionmentioning

confidence: 99%

Impact of group prenatal care on key prenatal services and educational topics in Malawi and Tanzania

Liese

Kapito

Chirwa

et al. 2020

Intl J Gynecology & Obste

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Objective To examine whether group prenatal care (PNC) increased key services and educational topics women reported receiving, compared with individual PNC in Malawi and Tanzania. Methods Data come from a previously published randomized trial (n=218) and were collected using self‐report surveys. Late pregnancy surveys asked whether women received all seven services and all 13 topics during PNC. Controlling for sociodemographics, country, and PNC attendance, multivariate logistic regression used forward selection to produce a final model showing predictors of receipt of all key services and topics. Results In multivariate logistic regression, women in group PNC were 2.49 times more likely to receive all seven services than those in individual care (95% confidence interval [CI] 1.78–3.48) and 5.25 times more likely to have received all 13 topics (95% CI 2.62–10.52). Conclusion This study provides strong evidence that group PNC meets the clinical standard of care for providing basic clinical services and perinatal education for pregnant women in sub‐Saharan Africa. The greater number of basic PNC services and educational topics may provide one explanatory mechanism for how group PNC achieves its impact on maternal and neonatal outcomes. ClinicalTrials.gov: NCT03673709, NCT02999334.

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“…In October 2015, at the Global Maternal and Newborn Health Conference in Mexico City, Jhpiego organized a panel of group antenatal care researchers working in low-and middle-income countries. The individuals on the panel represented group antenatal care initiatives in low-income countries that were conducted by the University of Michigan (Ghana), [19][20][21] the University of Illinois Chicago (Tanzania and Malawi), 22,23 and the nonprofit organization Possible (Nepal). 24 Panel organizers, participants, and others embarking on group antenatal care research in low-and middle-income countries, including Jhpiego (Kenya and Nigeria), 25,26 the University of California, San Francisco (Rwanda), [27][28][29][30] and Instituto Nacional de Salud Pública, Mexico, 31 met to exchange ideas and experiences.…”

Section: The Global Group Antenatal Care Collaborativementioning

confidence: 99%

Building a Global Evidence Base to Guide Policy and Implementation for Group Antenatal Care in Low‐ and Middle‐Income Countries: Key Principles and Research Framework Recommendations from the Global Group Antenatal Care Collaborative

Grenier¹,

Lori

Darney

et al. 2020

J Midwife Womens Health

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Evidence from high-income countries suggests that group antenatal care, an alternative service delivery model, may be an effective strategy for improving both the provision and experience of care. Until recently, published research about group antenatal care did not represent findings from low-and middle-income countries, which have health priorities, system challenges, and opportunities that are different than those in highincome countries. Because high-quality evidence is limited, the World Health Organization recommends group antenatal care be implemented only in the context of rigorous research. In 2016 the Global Group Antenatal Care Collaborative was formed as a platform for group antenatal care researchers working in low-and middle-income countries to share experiences and shape future research to accelerate development of a robust global evidence base reflecting implementation and outcomes specific to low-and middle-income countries. This article presents a brief history of the Collaborative's work to date, proposes a common definition and key principles for group antenatal care, and recommends an evaluation and reporting framework for group antenatal care research.

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

Cited by 34 publications

References 31 publications

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

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

Impact of group prenatal care on key prenatal services and educational topics in Malawi and Tanzania

Building a Global Evidence Base to Guide Policy and Implementation for Group Antenatal Care in Low‐ and Middle‐Income Countries: Key Principles and Research Framework Recommendations from the Global Group Antenatal Care Collaborative

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