Get in the Group — Early, Easily, Often
Group antenatal care in India is changing the prenatal paradigm for pregnant women in remote villages
By Harleen K. Sidhu and Indrani Kashyap
Rajasthan, India — Hira Devi married early last year and was expecting her first child a short while later. A 19-year-old living in a rural village tucked away in the mountains of India’s Aravali Range, Hira was focused on farming, family and her household chores.
One thing she wasn’t focused on? Antenatal care.
“There is so much to be done during the day! Where is the time to rest?” Hira said. Or to make the winding, mountainous — and in the rainy season, often treacherous — journey 10 kilometers to the nearest health facility.
She’s not alone. Across her region, just 9.7% of pregnant women receive four or more antenatal care (ANC) appointments, the minimum recommended by global health experts.
Innovating for the most remote
But today, Hira can receive respectful, empowering care in her community thanks to an exciting new program called Born Healthy. Through the program, health workers and nurses host Group Antenatal Care (G-ANC) sessions for pregnant women in the communities where they live. Since the program began, more than 300 pregnant women have participated.
G-ANC is a groundbreaking opportunity for pregnant women to receive the potentially lifesaving care they need for a safe, healthy pregnancy — screenings for HIV, malaria and hypertension — alongside, and with the support of, their neighbors who are also pregnant. In Hira’s community, auxiliary nurse-midwife Rajbala Jangid helps host the sessions, which include testing, diagnosis and treatment of common pregnancy-related issues, education and the provision of supplements like iron and folic acid.
A typical 2-hour session opens with a welcome ritual, during which women sit in a circle, introduce themselves and sing a song. Breaking into smaller groups, they might review progress on a birth plan they had written for themselves in a previous G-ANC meeting — with as simple a need as timely transportation to the health center. They encourage each other and offer support and ideas on how to ensure their health and that of their baby. Next, the women provide their own health information through a self-assessment, and come back together to discuss hygiene and nutrition with the entire group.
“If one client speaks up, then other women who might be facing similar issues, but are shy, also start sharing,” Rajbala said.
During the group session, women have one-on-one time with their provider. This gives the women a chance to go over personal issues privately, screen for key health issues like sexually transmitted infections, TB or malaria, and ask questions.
G-ANC empowers women with the knowledge, tools, care and social encouragement needed to have a healthy pregnancy. The groups represent a radical departure from a business-as-usual model in India, where, even in dense cities, fewer than four in 10 women attend the minimum recommended ANC visits. While centering groups, mommy and me groups and the like are often available in developed countries, G-ANC groups in India are pioneering high-quality group care for women like Hira. This new paradigm will help contribute to more lives saved in a country where an estimated 44,000 women die every year due to pregnancy-related causes.
“G” for group, but also for gain
While traditional ANC appointments might include farther travel distances, longer wait times, and shorter face-to-face time with a nurse or midwife, G-ANC participants gain in all those categories. Pregnant women and providers typically express higher satisfaction in G-ANC. Providers appreciate the time and focus they can give to the group. Participants report greater knowledge retention. They walk away with a better grasp of danger signs to keep an eye out for during pregnancy and their rights to respectful, quality care during labor and delivery.
Women learn to take their own blood pressure and keep track of their health needs and pregnancy progress. They also gain a sense of community, forming support groups throughout their pregnancy — groups that often stick together long after delivery.
In G-ANC groups in Kenya and Nigeria, postpartum care was included in the G-ANC model, and the entire family was invited to participate. This approach made health care a lifestyle, not just a moment in time, and involved men throughout the pregnancy, from pre- to post-birth. India represents a key next step, adapting the exciting successes of G-ANC in these countries for culturally relevant care in remote communities across Rajasthan.
A new group for Hira
G-ANC was just a short walk from Hira’s home — so when her community health worker first extended an invitation, she decided to give it a try. Hira was immediately hooked on the supportive care she could get so close to home and the important “to do” list to keep her and her baby healthy.
“I learned that we should keep things packed and ready, for going to the hospital at the time of delivery. We should eat four times a day — green vegetables — and we should take rest. We learned to check each other’s [blood pressure]. In case there is any weakness, we get to find that out,” Hira said.
“And no, I’ll not get pregnant again soon,” she continued, keeping in mind all that she learned in G-ANC about family planning.
In September 2019, Hira delivered a healthy baby girl, Krishna Kumari.
For women like Hira, G-ANC makes a healthy pregnancy and delivery possible. G-ANC is a trailblazing approach that will bring quality antenatal health services to more women, more often — showing that we’re better together!
Born Healthy is a collaborative effort from Jhpiego, the World Health Organization and GAPPS, through the Children’s Investment Fund Foundation, with support from the Ministry of Health of India.
