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 

By: Aleefia Somji, Kate Ramsey, Sean Dryer, Fredrick Makokha, Constance Ambasa, Brittany Aryeh, Kathleen Booth, Serge Xueref, Seneca Moore, Ralpher Mwenesi and Shafia Rashid

Publication: BMC Health Services Research, 29 July, 2022 DOI: https://10.1186/s12913-022-08200-1


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. Few studies show associations between GANC and various outcomes.

The authors employed a pre-post quasi-experimental design using mixed methods to assess a GANC model (Lea Mimba Pregnancy Clubs) at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, they tracked 1,652 women assigned to 162 GANC cohorts. Using an intention-to-treat approach, they conducted baseline and endline surveys with women attending immunization visits to assess outcomes, including experience of care, empowerment and self-efficacy, knowledge of healthy practices and danger signs, and practice of healthy behaviors, including ANC retention.

The proportion of survey respondents with knowledge of three or more danger signs during pregnancy more than tripled, from 7.1% at baseline to 26.4% at endline. Improvements occurred in women’s reports about their experience of care between baseline and endline, particularly in their assessment of knowledge and competence of health workers, respect shown by ANC providers, and women’s satisfaction with overall quality of care. Qualitatively, women and stakeholders noted improved 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. 

GANC offers the promise of enhancing women’s experience of care by providing improved counseling and social support. Additional research is needed to develop and test measures for empowerment, self-efficacy, and experience of care, and to understand the pathways whereby GANC affects changes in specific outcomes.