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Table 3 A “generic” model of group antenatal care for low- and middle-income countries

From: Group antenatal care models in low- and middle-income countries: a systematic evidence synthesis

Recruitment of women into group ANC takes place at the time of the first ANC visit, which follows the facility’s standard protocol. The “intake” visit follows the regular one-on-one format for ANC.
During this visit, the healthcare provider confirms pregnancy, performs initial lab tests and a physical exam, and screens for high-risk conditions. Pregnant women are then invited to join a group of 8-12 women with similar due dates to receive antenatal care in a group setting. If a woman chooses group ANC, she will be given the schedule for all her group care visits through the end of her pregnancy. She will receive care with the same group of women each time, and is expected to attend each of her group’s sessions, to help create a stable cohort.
The number of group ANC sessions may be tailored to match the number of visits recommended by global and local guidelines.
During the first group session, the women decide as a group whether they want support persons (for example, husband, mother, mother-in-law or sister) to participate in the sessions. Each session is facilitated by two group leaders, one of whom is a healthcare provider who can provide clinical care. Each session lasts 90 to 120 minutes, and has three parts: physical assessment, learning and education, and peer support.
Each group ANC session begins with self-assessments by the pregnant women and a physical assessment by a healthcare provider. During the first 30 minutes, one of the group leaders (for example, a nurse, medical assistant, or community health worker) helps the women take their own basic health measurements, such as blood pressure and weight, and reflect on some predetermined aspect of their physical and emotional wellbeing. Women may also be asked to think about or fill out a worksheet on a topic, which is used to inform the group discussion later. During this time, the other group leader—who must be a healthcare provider (for example, doctor, nurse, or midwife)— conducts the physical assessment for each woman, one at a time. This basic physical exam follows the ANC clinical guidelines recommended by the World Health Organization and national authorities. It takes place in a private area (like a corner) of the group space, and care is taken to ensure that each woman’s auditory and visual privacy and confidentiality are protected (for example, through the use of music or a screen or curtain).
After each of the assessments is completed, the women come together for the remainder of the session for group activities and discussion. During the discussions, the women and the providers sit together in a circle and take turns sharing, making sure that everyone has a chance to speak without interruption. The group leaders use a facilitative leadership style to promote the discussion. Using this style, they do not lecture to the women like in a classroom, but instead facilitate a discussion of the topics planned for the session and contribute to the discussion themselves along with the women. This part of the session is an opportunity for women to talk about how they are feeling, ask questions and share information with each other and the providers, build supportive relationships, and learn about pregnancy and birth. There is also time within each group session for informal socializing.
Each group session has a plan that includes specific content for clinical care and client education. Nevertheless, the session plan is flexible enough to make sure that the discussion is always relevant to the women and addresses their specific needs. Throughout the course of a group’s ANC sessions, there are opportunities for the women to provide feedback about their experiences in the group. This information can be used by the group leaders to evaluate and improve the program. There are also opportunities after each session for the group leaders to discuss how the group went and to talk about any areas for improvement in the group leadership or any clinical issues that need follow up.