WHO recommendations on antenatal care for a positive pregnancy experience

<strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience
other respected members), TBAs, husbands or
partners, and households (husbands or partners,
women, and other family members). Two intervention
packages included group education sessions for
women focusing on key knowledge and behaviour
around pregnancy and early neonatal care, including
promotion of ANC and other health education. One
intervention package included husband education
via booklets and audio cassettes. Training of TBAs
to recognize common obstetric and newborn
emergencies was a component of three intervention
packages. In one trial, telecommunication systems
with transport linkages were also set up as part of
the intervention package. In another trial, community
health committees were encouraged to establish an
emergency transport fund and use local vehicles,
in addition to advocacy work, household visits and
women’s meetings.
Maternal outcomes
Moderate-certainty evidence indicates that
intervention packages with community mobilization
and antenatal home visits probably have little or no
effect on maternal mortality (2 trials; RR: 0.76, 95%
CI: 0.44–1.31).
Fetal and neonatal outcomes
Moderate-certainty evidence indicates that
intervention packages with community mobilization
and antenatal home visits probably reduce perinatal
mortality (3 trials; RR: 0.65, 95% CI: 0.48–0.88).
Coverage outcomes
High-certainty evidence shows that intervention
packages with community mobilization and antenatal
home visits improve ANC coverage of at least one
visit (4 trials; RR: 1.76, 95% CI: 1.43–2.16). However,
moderate-certainty evidence indicates that they
probably have little or no effect on ANC coverage
of at least four visits (1 trial; RR: 1.51, 95% CI: 0.50–
4.59) or facility-based birth (3 trials; RR: 1.46, 95%
CI: 0.87–2.46).
Additional considerations
• nThe GDG also considered evidence on antenatal
home visits as a stand-alone intervention, but
did not make a separate recommendation on
this intervention due to the lack of evidence of
benefits related to the ANC guideline outcomes.
In brief, evidence of moderate- to high-certainty
suggests that stand-alone antenatal home visits
have little or no effect on ANC visit coverage
of at least four visits (4 trials; RR: 1.09, 95% CI:
0.99–1.22), facility-based birth (4 trials; RR: 1.08,
95% CI: 0.87–1.35), perinatal mortality (4 trials;
RR: 0.91, 95% CI: 0.79–1.05) and preterm birth
(1 trial; RR: 0.88, 95% CI: 0.54–1.44) (see Web
supplement).
• nThe 2013 <strong>WHO</strong> <strong>recommendations</strong> on postnatal care
of the mother and newborn include the following
recommendation:
“Home visits in the first week after birth are
recommended for care of the mother and
newborn (strong recommendation based
on high-quality evidence for newborns and
low-quality evidence for mothers).” This
recommendation is accompanied by the
remark “Depending on the existing health
system in different settings, these home
visits can be made by midwives, other skilled
providers or well trained and supervised
CHWs [community health workers]” (196).
• nThe 2011 <strong>WHO</strong> guidelines on Preventing early
pregnancy and poor reproductive outcomes among
adolescents in developing countries strongly
recommend the following in relation to the
outcome “Increase use of skilled antenatal,
childbirth and postnatal care among adolescents”:
––“Provide information to all pregnant adolescents
and other stakeholders about the importance of
utilizing skilled antenatal care.”
––“Provide information to all pregnant adolescents
and other stakeholders about the importance of
utilizing skilled childbirth care.”
––“Promote birth and emergency preparedness
in antenatal care strategies for pregnant
adolescents (in household, community and
health facility settings)” (197).
• nSeveral <strong>WHO</strong> <strong>recommendations</strong> included in the
2015 <strong>WHO</strong> <strong>recommendations</strong> on health promotion
interventions for maternal and newborn health
are relevant to community-based interventions to
improve communication and support for women
during pregnancy (198) – these are presented in
Box 3.
Values
See “Women’s values” at the beginning of section 3.E:
Background (p. 86).
Resources
A systematic review of the cost–effectiveness of
strategies to improve the utilization and provision
of maternal and newborn health care in low- and
lower-middle-income countries reported that
there was reasonably strong evidence for the
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