Sexual and reproductive health

Positive experiences, key to antenatal care uptake and quality

26 June 2019 – Results from a Cochrane qualitative evidence synthesis suggests that women use antenatal care if they see it as a positive experience that fits with their beliefs and values, is easily accessible and affordable and treats them as an individual.

The review, covering 85 studies and published in the Cochrane Library, shows that women want care that makes them feel that they and their baby are safe, and is provided by kind, caring, culturally sensitive, flexible, and respectful staff that give support and reassurance about their health and of their babies. Women also value tests and treatments that are offered when needed, as well as being provided relevant information and advice.

Of the 85 studies in the synthesis, 46 explored the views and experiences of healthy pregnant or postnatal women, 17 studies explored the views and experiences of healthcare providers and 22 studies incorporated the views of both women and healthcare providers. Confidence in each finding was assessed using GRADE-CERQual.

Antenatal care consultation, Cambodia
UNICEF

The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. Fifty-two findings were developed in total and these were organized into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence). The third domain was sub-divided into two conceptual areas: personalised supportive care, and information and safety. Two lines of argument, using high- or moderate-confidence findings were also developed.

The studies took place in 41 countries, including eight high-income countries, 18 middle-income countries and 15 low-income countries, in rural, urban and semi-urban locations. Fifty-two findings were developed in total and these were organized into three thematic domains: socio-cultural context (11 findings, five moderate- or high-confidence); service design and provision (24 findings, 15 moderate- or high-confidence); and what matters to women and staff (17 findings, 11 moderate- or high-confidence). The third domain was sub-divided into two conceptual areas: personalised supportive care, and information and safety. Two lines of argument, using high- or moderate-confidence findings were also developed.

The authors conclude that the review complements existing effectiveness reviews of antenatal care provision and adds essential insights as to why a particular type of antenatal care provided in specific local contexts may or may not be acceptable, accessible, or valued by some pregnant women and their families or communities.

Those providing, and funding services should consider the three thematic domains identified by the review as basis for service development and improvement. Such developments should include pregnant and postnatal women, community members and other relevant stakeholders.

Pregnant women needlessly dying

Maternal deaths are unacceptably high, with about 830 women dying from pregnancy or childbirth-related complications around the world every day. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care.

In 2015, it’s estimated that more than 300 000 women died during and following pregnancy and childbirth. Nearly all these deaths occurred in low-resource settings.

Quality health care during pregnancy and childbirth can prevent many of these deaths, yet globally, only 64% of women receive antenatal care four or more times throughout their pregnancy.

Antenatal care: essential for pregnant women

A doctor does an antenatal check up to a pregnant woman, Pakistan
UNICEF/Ramoneda

A core component of maternity care, antenatal care screens a woman and her baby for actual and potential problems as the pregnancy progresses and for treating any complications that may arise.

When women receive antenatal care, they are provided with support, reassurance, and information about pregnancy and birth, and tests and examinations to see if they and their baby are healthy. Problems or issues are then managed during the contact and, if needed, women are referred to other care providers.

Antenatal care is a vital opportunity for health providers to deliver care, support and information to pregnant women. This includes promoting a healthy lifestyle, including good nutrition, detecting and preventing diseases, providing family planning counselling, and supporting women who may be experiencing intimate partner violence.

While the World Health Organization (WHO) recommends that all pregnant women receive antenatal care, women do not always avail of this care, either because they do not think it is important, or because they cannot access this service. The quality of antenatal care and how women are treated plays a role as well.

The perspective of healthcare workers

The findings also suggest that healthcare staff want to be able to provide the same kinds of care that women want. They want to work in properly funded antenatal services that give them proper support, pay, training and education. They believe this helps them to have enough time to treat each pregnant woman as an individual, and to have the knowledge, skills, resources and equipment to do their job well.

WHO recommendations on antenatal care

The preliminary findings of this review contributed to the series of recommendations released by WHO in 2016 to improve the quality of antenatal care; reduce the risk of stillbirths and pregnancy complications; and give women a positive pregnancy experience. The results of this review, which include studies published up to February 2019, reinforce this guideline. Endorsed by the UN Secretary-General, it complements existing WHO recommendations on managing specific pregnancy-related complications.

Related links