Table 2.

Lead-in prompts for focus group discussion

Topic	Question
General pregnancy questions
Gestation	• What is the normal length of pregnancy? • How is expected date of delivery determined?
Prenatal and obstetric care	• Why would women not come or come late for antenatal care appointments? • Do you know of women who plan to deliver at home or in their village? • Would it matter if the baby was being born too soon? • On their due date?
Preterm birth
Counseling	• What if a woman has pain a few months prior to her expected delivery date?
Epidemiology	• How common is preterm birth? • Scripted prompt: “If you had ten women gathered who have had children, how many would have had a preterm birth? One? Two? Three? Four? Five? Six?” • What are causes of women delivering early, like at 6 or 7 months? • At what gestational age can a baby survive?
Recurrent preterm birth	• Have you heard of recurrent preterm birth? • If a woman has a history of preterm birth (800 g or 1 kg or even 2 kg), would she be referred antenatally?
Management of preterm birth	• Why would a woman not come to a health center when in preterm labor or with antenatal problems? • What can be done at a health center if preterm delivery occurs or might occur? • Have you ever heard of medicines that can be given to the mother to make the baby more ready if she delivers early or that can prevent the recurrence of preterm labor? • Have you heard about using antenatal steroids for fetal lung maturity? Shots to the mom for helping a baby breathe better? What have you heard? Any potential harm? When can they be used? When can they not be used? • Would women come in early if medications were available?
Prevention of preterm birth	• Are there ways to prevent preterm birth?
Smoking and tobacco
General information	• Do people in Malawi smoke tobacco? Chew or gum tobacco? What are your thoughts on pregnant women smoking or chewing or gumming tobacco?
Risks of smoking or tobacco	• Are there potential risks or harm to chewing or smoking tobacco?
Oral health and xylitol-containing gum
Chewing gum	• Would you believe it if someone told you that chewing gum might help prevent preterm birth? • Is gum acceptable?
Oral health and preterm birth	• If we tell you that the same bacteria that can cause gum disease may cause preterm birth, would you believe it?
General tooth care	• What is usual tooth care?