WHO recommendations on antenatal care for a positive pregnancy experience

<strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience
groups included more than 30% pregnant women
(4 trials; RR: 0.67, 95% CI: 0.47–0.95).
Fetal and neonatal outcomes
Low-certainty evidence suggests that PWGs may
reduce perinatal mortality (6 trials; RR: 0.91, 95% CI:
0.82–1.01). This interpretation is confirmed by the
sensitivity analysis that included only those trials in
which pregnant women comprised more than 30%
of the women’s groups (4 trials; RR: 0.85, 95% CI:
0.77–0.94).
Coverage outcomes
Low-certainty evidence suggests that PWGs may
have little or no effect on ANC coverage of at least
four visits (3 trials; RR: 1.05, 95% CI: 0.78–1.41),
facility-based delivery (5 trials; RR: 1.04, 95% CI:
0.89–1.22) and ANC coverage of at least one visit
(6 trials; RR: 1.43, 95% CI: 0.81–2.51). However,
evidence from the sensitivity analysis, which included
only those trials in which pregnant women comprised
more than 30% of the women’s groups, suggests that
PWGs may increase ANC coverage of at least one
visit (3 trials; RR: 1.77, 95% CI: 1.21–2.58).
Additional considerations
Findings are consistent with a 2013 review of PWGs
(191), which provided low-quality evidence that
women’s groups reduced maternal mortality (OR:
0.63, 95% CI: 0.32–0.94) and moderate-quality
evidence that women’s groups reduced neonatal
mortality (OR: 0.77, 95% CI: 0.65–0.90). The latter
review formed the evidence base for the 2014 <strong>WHO</strong>
recommendation on PWGs (183).
• nThe existing <strong>WHO</strong> recommendation on PWGs is
as follows:
“The implementation of community
mobilization through facilitated participatory
learning and action cycles with women’s groups
is recommended to improve maternal and
newborn health, particularly in rural settings
with low access to health services (strong
recommendation; moderate-quality evidence
on neonatal mortality, low-quality evidence
for maternal mortality and care-seeking
outcomes)” (183).
The GDG that developed this recommendation
advised that any intervention designed to
increase access to health services should be
implemented in tandem with strategies to
improve the quality of the health services. It
also highlighted the need for more research
to understand the effects of community
mobilization on care-seeking outcomes in
different contexts, and recommended the need
for close monitoring and evaluation to ensure
high quality implementation adapted to the
local context.
Values
See “Women’s values” at the beginning of section
3.E: Background (p. 86).
Resources, Equity, Acceptability and Feasibility
See the “Summary of evidence and considerations”
for Recommendation E.4.2.
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