WHO recommendations on antenatal care for a positive pregnancy experience

E.4.2: Community mobilization and antenatal home visits
RECOMMENDATION E.4.2: Packages of interventions that include household and community
mobilization and antenatal home visits are recommended to improve antenatal care utilization
and perinatal health outcomes, particularly in rural settings with low access to health services.
(Context-specific recommendation)
Remarks
• The GDG agreed that the extent to which these packages improve communication and support for
pregnant women is not clear.
• As a stand-alone intervention, the evidence does not support the use of antenatal home visits by lay
health workers during pregnancy to improve ANC utilization health outcomes. While the quality and
effectiveness of communication during home visits, and the extent to which they increase support
for women, is not clear, antenatal home visits may be helpful in ensuring continuity of care across the
antenatal, intrapartum and postnatal periods and in promoting other healthy behaviour.
• Stakeholders need to be clear that antenatal home visits by lay health workers do not replace ANC visits.
• Stakeholders should implement health system strengthening interventions alongside these communitybased
interventions.
• Health-care providers need initial and ongoing training in communication with women and their partners.
For women’s groups and community mobilization, providers also need training on group facilitation, in the
convening of public meetings and in other methods of communication.
• Information for women and community members should be provided in languages and formats accessible
to them and programme planners need to ensure that health-care providers/facilitators have reliable
supplies of appropriate information materials.
• Programme planners should be aware of the potential for additional costs associated with home visits and
community mobilization initiatives, including the potential need for extra staff and travel expenses.
• When considering the use of antenatal home visits, women’s groups, partner involvement or community
mobilization, programme planners need to ensure that these can be implemented in a way that respects
and facilitates women’s needs for privacy as well as their choices and their autonomy in decision-making.
By offering pregnant women a range of opportunities for contact, communication and support, their
individual preferences and circumstances should also be addressed.
• Further research is needed on the acceptability and feasibility of mixed-gender communication, the
optimal methods for community mobilization, the best model for integration with health systems,
continuity elements of home visits, and the mechanisms of effect of these interventions.
Summary of evidence and considerations
Effects of communication and support provided
to women through community mobilization and
home visits during pregnancy versus standard
care (EB Table E.4.2)
The evidence on the effects of community
mobilization and antenatal home visits was
synthesized from data derived from a Cochrane
review of health system and community-level
interventions for improving ANC coverage and health
outcomes (175). Four large cluster-RCTs conducted
in rural Bangladesh, India and Pakistan contributed
data on packages of interventions involving
community mobilization and antenatal home visits
versus no intervention (192–195). Health system
strengthening occurred in both the intervention
and control groups in two of the trials. The focus of
these packages was generally to promote maternal
health education, ANC attendance and other careseeking
behaviour, tetanus toxoid vaccinations
and iron and folic acid supplements, and birth and
newborn-care preparedness. Household visits
were performed by trained lay health workers and
consisted of at least two visits during pregnancy.
In two trials, these visits were targeted to occur at
12–16 weeks of gestation and 32–34 weeks; in one
trial, these visits both occurred in the third trimester;
and in the fourth trial the timing of the visits was
not specified. Multilevel community mobilization
strategies included advocacy work with community
stakeholders (community leaders, teachers, and
Chapter 3. Evidence and <strong>recommendations</strong> 95