Strength in Numbers: Is Group Antenatal Care the Way Forward?
Traditionally, antenatal care (ANC) visits have consisted of one-on-one meetings between a pregnant woman and her provider. More recently, clinicians have been experimenting with group ANC, gathering several women at similar gestational ages to create a more interactive, supportive environment.
A brief history
A recent expert review published in the American Journal of Obstetrics and Gynecology reviewed the history of group ANC and summarized existing evidence on its effectiveness. The concept of group ANC was introduced in a 1988 article published in the American Journal of Maternal Child Nursing and described a program for adolescent mothers. To date, the majority of published studies have been conducted in the United States (U.S.) and other high-income countries. Perhaps the most widely recognized model is CenteringPregnancy, which started in the U.S. during the 1990s. While researchers and clinicians have begun adapting group ANC models in other settings, including in sub-Saharan Africa, the literature on global implementation is scarce.
Current state of the evidence
Much of the evidence on maternal and newborn health outcomes among women who participate in group ANC is limited to evaluations of CenteringPregnancy models in the U.S. While it is clear that group ANC is not harmful to women compared to traditional models, evidence that ANC leads to positive maternal health outcomes, such as reductions in preterm birth, fewer admissions to the neonatal intensive care unit and increases in breastfeeding, have been inconsistent and inconclusive.
Some studies involving adolescent girls in the U.S. have shown improvements in patient satisfaction, postpartum family planning uptake and adequate weight gain. Furthermore, black women in the U.S.—who have significantly higher rates of preterm delivery compared to their white counterparts—may benefit more from group ANC. Qualitative evidence has also highlighted potential benefits for providers of group ANC including higher job satisfaction and more opportunities for education and support.
Nevertheless, implementing group ANC can be challenging. Barriers for health systems and facilities implementing group ANC models include inadequate physical space, lack of additional administrative support, limited capacity for facilitator training and financial limitations.
Research gaps
While there have been advocacy efforts to raise public awareness about group ANC, the question of whether group models are more beneficial than traditional one-on-one models remains unanswered. Given that group ANC is highly dependent on social, economic and other contextual factors, exploring and evaluating locally adapted models is critical.
The new World Health Organization’s ANC recommendations call for additional attention to innovative ANC delivery strategies to improve women’s pregnancy experiences worldwide. More research on group ANC around the globe would help to determine its feasibility and acceptability among women living in diverse settings with different needs, identify barriers and facilitators to implementation and draw conclusions about its merit as an evidence-based practice.
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