WHO recommendations on antenatal care for a positive pregnancy experience

Box 3: Relevant <strong>recommendations</strong> from the 2015 <strong>WHO</strong> <strong>recommendations</strong> on health promotion
interventions for maternal and newborn health
Recommendation 1: Birth preparedness and complication readiness interventions are recommended to
increase the use of skilled care at birth and to increase the timely use of facility care for obstetric and newborn
complications. (Strong recommendation, very low-quality evidence.)
Recommendation 2: Interventions to promote the involvement of men during pregnancy, childbirth and after
birth are recommended to facilitate and support improved self-care of women, improved home care practices
for women and newborns, and improved use of skilled care during pregnancy, childbirth and the postnatal
period for women and newborns. (Strong recommendation, very low-quality evidence.) These interventions are
recommended provided that they are implemented in a way that respects, promotes and facilitates women’s
choices and their autonomy in decision-making, and supports women in taking care of themselves and their
newborns. In order to ensure this, rigorous monitoring and evaluation of implementation is recommended.
Recommendation 3 on interventions to promote awareness of human, sexual and reproductive rights and the right
to access quality skilled care: Because of the paucity of evidence available, additional research is recommended.
The GDG supports, as a matter of principle, the importance for MNH programmes to inform women about their
right to health and to access quality skilled care, and to continue to empower them to access such care.
Recommendation 6 on partnership with traditional birth attendants (TBAs): Where TBAs remain the
main providers of care at birth, dialogue with TBAs, women, families, communities and service providers is
recommended in order to define and agree on alternative roles for TBAs, recognizing the important role they can
play in supporting the health of women and newborns. (Strong recommendation, very low-quality evidence.)
Recommendation 7: Ongoing dialogue with communities is recommended as an essential component in defining
the characteristics of culturally appropriate, quality maternity care services that address the needs of women and
newborns and incorporate their cultural preferences. Mechanisms that ensure women’s voices are meaningfully
included in these dialogues are also recommended. (Strong recommendation, very low-quality evidence.)
Recommendation 11: Community participation in quality-improvement processes for maternity care services is
recommended to improve quality of care from the perspectives of women, communities and health-care providers.
Communities should be involved in jointly defining and assessing quality. Mechanisms that ensure women’s voices
are meaningfully included are also recommended. (Strong recommendation, very low-quality evidence.)
Recommendation 12: Community participation in programme planning, implementation and monitoring is
recommended to improve use of skilled care during pregnancy, childbirth and the postnatal period for women and
newborns, increase the timely use of facility care for obstetric and newborn complications and improve maternal
and newborn health. Mechanisms that ensure women’s voices are meaningfully included are also recommended.
(Strong recommendation, very low-quality evidence.)
Source: <strong>WHO</strong>, 2015 (198).
cost–effectiveness of the use of PLA cycles (199).
Estimated costs per life saved for PLA cycle
interventions alone was US$ 268 and for community
mobilization combined with home visits during
pregnancy and/or health system strengthening,
costs ranged from US$ 707 to US$ 1489 per death
averted. However, costs of these interventions
are difficult to estimate and depend on context.
Costing must also take into account the facilitators’
time, training and supervision; these elements are
considered key to the quality of implementation and
the success of the intervention.
Equity
Interventions such as PLA cycles, community
mobilization and home visits during pregnancy are
a way of facilitating dialogue and action with, and
empowering, disadvantaged populations to engage in
efforts to improve health and to strengthen broader
community support. The women’s groups PLA cycles,
in particular, were conducted in marginalized areas
where other support mechanisms often do not exist.
Interventions to engage male partners/husbands and
others in the community to support women to make
healthy choices for themselves and their children
Chapter 3. Evidence and <strong>recommendations</strong> 97