WHO recommendations on antenatal care for a positive pregnancy experience

Senegal, Sri Lanka, Yemen and Zambia, was
conducted between 1984 and 1988 (176). The
study reported that “The introduction of the HBMR
increased the diagnosis and referral of at-risk
pregnant women and newborn infants, improved
family planning and health education, increased
tetanus toxoid immunization, and provided a
means of collecting health information in the
community. The HBMR was liked by mothers,
community health workers and other healthcare
personnel because, by using it, the mothers
became more involved in looking after their own
health and that of their babies.”
Values
See “Women’s values” at the beginning of section 3.E:
Background (p. 86).
Resources
Resource implications differ depending on whether
electronic or paper-based systems are used.
Electronic systems require more resources. Paperbased
systems require the production of durable,
transportable journals, as well as systems for keeping
copies. The need to adapt and/or translate journals
may add to costs.
Acceptability
Qualitative evidence suggests that women from a
variety of settings are likely to favour carrying their
case notes because of the increased opportunity to
acquire pregnancy and health-related information
and the associated sense of empowerment this brings
(high confidence in the evidence) (22). There may
be potential for abuse of the system in some LMIC
settings, for example, by limiting access to hospitals
for women who do not have case notes, particularly
where maternity services are under-resourced
(moderate confidence in the evidence). Further
evidence from a mixed-methods review supports
RCT evidence that women feel more satisfied when
they carry, or have access to, their own case notes
(177). These review findings were not subject to
GRADE-CERQual assessments of confidence, and
were derived primarily from high-income settings
(36 out of 37 studies). Findings also suggest that
providers are generally happy for women to carry
their own case notes, but feel the implementation of
the approach may generate additional administrative
responsibilities. Providers also raised concerns about
data security, sensitivity of the shared information,
and the potential for data to be lost because of
fragmented systems.
<strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience
Equity
The GDG considered that women-held case notes
could be subject to abuse and used to discriminate
against women who do not have them, or if the
information contained in the notes is associated with
stigma (e.g. HIV-positive status). Less-educated
women with lower health literacy may be less able
to read and understand their own case notes, which
might perpetuate inequalities.
Feasibility
There may be prohibitive additional costs associated
with using an electronic system (USB memory sticks,
software packages, etc.) in some LMIC settings (high
confidence in the evidence), although paper-based
records may require little in the way of extra cost or
resources (45).
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