Lea Mimba Pregnancy Clubs: Findings from an Evaluation of the Group ANC Model

May 08, 2019

Lea Mimba Pregnancy Clubs: Findings from an Evaluation of the Group ANC Model

By: Shafia Rashid and Kate Ramsey

Judy Moraa is one of many women who participated in the Lea Mimba Pregnancy Clubs at one of six health facilities in Kakamega County in western Kenya. Lea Mimba, which means “take care of your pregnancy” in Swahili, is a forum where the same health provider and pregnant women come together over the course of a pregnancy, allowing Judy and others to learn essential information, practice self-care, and provide each other with emotional and social support to cope with the stresses of pregnancy.

Beginning in 2017, Management Sciences for Health (MSH) worked in close partnership with the national ministry of health, the county health management team, the national nurses association (the Kenya Progressive Nurses Association or KPNA), and M4ID, a social impact design company specializing in development and health, to test the effects and acceptability of the Lea Mimba Pregnancy Clubs. This innovative group model for antenatal care (ANC) is more responsive to women’s needs for social support without overburdening health providers.  Over the course of 10 months, more than 1,600 women were enrolled in 177 Lea Mimba clubs across the six project sites.

Using mixed qualitative and quantitative methods, we assessed the effects of the group ANC model on:

Information was collected through a survey, focus groups and interviews with women and other stakeholders including county health officials, health providers, facility managers, and community health volunteers, to understand the model’s acceptability and its effects on the quality of antenatal care. Through observations and time diaries we assessed the operational requirements for introducing and sustaining the pregnancy clubs, including workflow and context mapping.

Overall, the findings were mixed, with positive effects in some areas and no statistically significant effects in others:

Qualitative data shows that the pregnancy clubs were acceptable to women, health care providers, and other stakeholders. All respondents appreciated the facilitated learning style, which provided practical knowledge and promoted mutual learning between women and health providers around, for example, community beliefs on pregnancy and childbirth.

Women also discussed the social support they received from other women and from the health provider, how it enabled problem-solving and coping skills and created a safe space for discussion and sharing. However, implementation challenges, including long waiting and staffing shortage, made it less acceptable for some.

The implementation period was likely too short to see the full effects of the model at the facility and population level. Additional research can help us better understand the intermediate pathways leading to observed changes in utilization and practice of healthy behaviors. For example, while women described changes in learning and empowerment during qualitative interviews, those results were not replicated in the quantitative measurements, indicating a need to more accurately measure changes in beliefs and behavior related to self-efficacy and social support.

Learn more about the findings and lessons learned from the project’s implementation:

Pregnancy Clubs reflects an important change in how ANC services are delivered and organized and how health providers and women interact with each other. While this approach holds promise for better meeting the social support and informational needs of pregnant women and for improving the quality and coverage of ANC, further efforts to address the logistical and operational elements are needed to ensure that challenges are addressed and that group ANC can be scaled and sustained.