Person-centered group antenatal care in Eastern Uganda: Reaching women through pregnancy clubs

Improving the quality of care that women experience during pregnancy, childbirth, and the postpartum period has become a major global priority. Achieving good quality care requires not only clinical improvements, but also a person-centered approach that takes into account women’s and health workers’ needs and perspectives.

In 2016, the World Health Organization (WHO) updated its antenatal care guidelines, calling for a positive pregnancy experience through holistic, person-centered antenatal services that provide pregnant women with emotional support and advice in addition to the standard clinical assessments.

Group antenatal care, initially developed in the U.S. several decades ago, is a promising model that responds to women’s health and information concerns during pregnancy. Facilitated by a health provider, usually a nurse or midwife, group antenatal care offers a forum for pregnant women to learn more about their pregnancies, share their experiences, receive essential health and self-care information, and provide social and emotional support to each other within the group. Health care providers meet individually with group participants after the group sessions for routine physical and clinical care and to discuss any confidential issues. Group antenatal care can also benefit health care providers through increased job satisfaction without substantially increasing the amount of time required.

MSH is testing the feasibility and acceptability of person-centered, group antenatal care in the context of eastern Uganda. Working in collaboration with Scope, a social impact company specializing in human-centered, innovative solutions to health problems in low-resource settings, we co-designed a pregnancy club model with women and health providers to ensure it met their needs and expectations. Scope then tested a pregnancy club prototype with women and health providers and refined the model according to their feedback.

Now, health care providers are leading pregnancy clubs in six health facilities. Pregnancy club members begin and end each session with a ritual of opening and closing a simple, circular mat made of local fabric. The women gather around the mat and roll out scrolls containing picture cards of health discussion topics, although the participants may also introduce other topics for discussion. Women pass around a ball so that everyone has a turn to speak.

Preliminary findings from our qualitative research indicate that pregnant women, midwives, and district and national Ministry of Health officials really appreciate the benefits of the group sessions. Many of the women described developing lasting friendships with other women and a more trusting bond with the midwife, who–they hoped–would attend their births. Similarly, participating nurses and midwives described stronger relationships with the women. And members of the District Health Management Team regarded the group sessions as an important improvement in the quality of antenatal care.