Adapting the Centering Pregnancy Model Globally: Challenges and Outcomes

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Our long-term goal is to improve maternal-infant outcomes in low-resource settings by improving quality of antenatal care (ANC). In the US, CenteringPregnancy (CP), a model of group ANC, is associated with improved perinatal outcomes. Exporting group care models to sub-Saharan Africa presents numerous challenges including: addressing higher rates of HIV, severe provider shortages, large client volume, and fewer antenatal visits. In Phase 1, the model was adapted and acceptability and feasibility were assessed. Phase 2 included a randomized pilot study to assess maternal and infant outcomes and identify strategies for a large clinical trial.

Methodology: Phase 1: key administrators and healthcare workers were interviewed. Content that exceeded national standards and maintained model fidelity was developed. Two pilot sessions were conducted in Malawi. Phase 2: a pilot (n=192) was conducted in Dar-es-Salaam, Tanzania (urban) and Kabudula, Malawi (rural) from August 2014 – April 2015. Pregnant women with similar due dates were randomized to group or individual care and participated in interviews at baseline, late pregnancy, and postpartum.

Results: Phase 1: Qualitative assessments indicated the acceptability and feasibility of conducting group care in both settings. Midwives and women were enthusiastic and satisfied with group care. Phase 2: All data on enrolled women are currently being analyzed and qualitative evaluation of midwives and participants is being reviewed. Results comparing healthcare utilization, treatment adherence, quality of services, maternal psychosocial health, place of delivery, satisfaction, and perinatal outcomes will be presented.

Conclusion: Data showed group care could be implemented while maintaining model fidelity. Challenges were identified and valuable information regarding systems issues related to scaling the program up will be important to address in the clinical trial. Data from this study supports the urgency to innovate and change the current antenatal model and reduce missed opportunities to improve maternal and child health.