Group-based antenatal care (G-ANC): an innovative approach to empower birth preparedness and complication readiness (BPCR), particularly in resource-constrained setting

Commentary on: Kukula VA, Awini E, Ghosh B, Apetorgbor V, Zielinski R, Amankwah G, Ofosu WK, James K, Williams JEO, Lori JR and Moyer CA. Effect of group antenatal care versus individualised antenatal care on birth preparedness and complication readiness: a cluster randomised controlled study among pregnant women in Eastern Region of Ghana. BMC Pregnancy Childbirth. 2024 Aug 16;24(1):546. doi: 10.1186 /s12884-024-06743-1. PMID: 39152408; PMCID: PMC11328422.

Implications for practice and research.

• The implementation of group-based antenatal care (G-ANC) should be prioritised, as it significantly enhances patient satisfaction and improves maternal and neonatal health outcomes, ensuring the sustainability and success of this intervention while contributing to holistic and equitable maternity care practices.

• Further research on the scalability and impact of G-ANC could provide valuable insights into adapting such models to diverse healthcare systems globally, with studies focused on its effectiveness in reducing maternal and neonatal mortality across various socioeconomic and cultural contexts while also exploring its potential to address racial disparities in maternal and child health outcomes, guiding future strategies for equity in healthcare.

Context

Birth preparedness and complication readiness (BPCR) is a critical component of safe motherhood initiatives to improve maternal and neonatal outcomes by promoting timely care during pregnancy, childbirth and postpartum periods. BPCR empowers pregnant women, families and communities to anticipate and prepare for normal births and potential complications. By addressing barriers and scaling up awareness and resources, BPCR can significantly improve outcomes for mothers and newborns, particularly in low- and middle-income countries.

Methods

The article of Kukula et al. is a 5-year, cluster randomised controlled trial among health facilities in Ghana. The population considered was pregnant women during the first trimester of pregnancy, taken in charge by Health Facilities. These facilities were grouped into pairs with similar characteristics, such as facility type, district, number of monthly antenatal care (ANC) registrants and then randomised to Group ANC (G-ANC) or Individual ANC (I-ANC). The intervention consists of eight meetings characterised by 2-hour interactive group sessions, facilitated by midwives trained in G-ANC methods. Clinical assessments were collected at five timepoints, and results are presented comparing baseline (T0) to 34 weeks’ gestation to 3 weeks postdelivery (T1). The assessments were based on two scales with items that women were asked to recall: knowledge of danger signs during pregnancy, which included 14 items, and preparation for birth, which included 11 items.¹

Findings

Improvements were observed in both I-ANC and G-ANC with regard to birth preparedness but G-ANC significantly improved knowledge on the number of pregnancy danger signs that women could identify, as well as increasing the percentage of women who could identify individual danger signs. G-ANC group was also linked to an increase in recognition of preventive measures, which is a cornerstone of maternal and child health. BPCR scores were significantly greater in the G-ANC group than the I-ANC group. The elements of BPCR, such as arranging for emergency transport, saving money for transportation and identifying someone to accompany the woman to the facility, show significant differences between two groups.

Commentary

Bridging clinical expertise and health promotion with community-focused care ensures the successful integration of G-ANC into maternity care. The implementation of G-ANC in nursing/midwifery practice transforms ANC into a more inclusive, interactive and patient-centred approach. G-ANC, moreover, contributes to holistic and equitable maternity care. G-ANC, as proven also by the article of Kukula et al., is an evidence-based approach, which improves maternal and neonatal outcomes while fostering a supportive and engaging environment for pregnant women.^{2 3}

ANC plays a crucial role in improving maternal and neonatal health outcomes. BPCR is a practical, evidence-based approach to reduce maternal and neonatal mortality and morbidity. Its success depends on collaborative efforts among healthcare systems, communities and families. Disparities in access and utilisation of ANC persist, influenced by socioeconomic, cultural and logistical barriers.⁴ That is why Ghana’s adoption of international maternal health strategies, including the WHO recommendations,⁵ has aimed to enhance ANC coverage and quality, promoting innovative, community-centred approaches as the key to achieving universal access to high-quality ANC. G-ANC, in particular, combines individual clinical assessments with group education and peer support improving maternal--neonatal outcomes, reducing preterm births, increasing healthcare engagement and enhancing patient satisfaction.⁶ Widely adopted globally, it promotes health equity, psychosocial well-being and cost-effectiveness in both high- and low-resource settings.⁵ G-ANC is rooted in principles of patient-centred care and emphasises education, empowerment and community-building among pregnant women. With proper training and resources, nurses can effectively implement and sustain G-ANC programmes, contributing to holistic and equitable maternity care. Research and investment in G-ANC can further enhance its scalability and impact, contributing to global maternal and child health goals. New results, moreover, could have implications for the design of sustainable prenatal services that might contribute to the reduction of racial disparities.