WHO recommendations on antenatal care for a positive pregnancy experience

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may help to address inequalities. However, when engaging men, it is important to consider women’s preferences, as including male partners could also have a negative effect for women who would prefer to discuss pregnancy-related and other matters without their partner’s involvement. Acceptability Qualitative evidence suggests that women in a variety of settings and contexts readily engage with interventions designed to increase communication and support, provided they are delivered in a caring and respectful manner (high confidence in the evidence) (22). The use of women’s groups is likely to fulfil two key requirements of ANC from a woman’s perspective – the opportunity to receive and share relevant information and the opportunity to develop supportive relationships with other women and health-care providers (high confidence in the evidence). Evidence from women and providers in LMICs also highlighted the importance of active community engagement in the design and delivery of informational-based services, especially in communities where traditional beliefs may differ from conventional understandings (moderate confidence in the evidence). Qualitative evidence from providers suggests that there is a willingness to supply pregnancy-related information and offer psychological/emotional support to women provided that resources are available (high confidence in the evidence) and the services are delivered in a coordinated, organized manner with appropriate managerial support (moderate confidence in the evidence) (45). Feasibility Qualitative evidence suggests that, where health-care providers are involved in facilitating women’s groups, they may need additional training to help with the facilitative components and this may be a barrier in some resource-poor settings (high confidence in the evidence). Similarly, the extra costs associated with home visits in terms of additional staff and extra resources may limit implementation in some LMICs (high confidence in the evidence) (45). It has been suggested that community-based interventions introduced through existing public sector health workers and local health systems may be more feasible and more likely to succeed than projectbased interventions (200). <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience 98
E.5: Task shifting components of antenatal care delivery RECOMMENDATION E.5.1: Task shifting the promotion of health-related behaviours for maternal and newborn health a to a broad range of cadres, including lay health workers, auxiliary nurses, nurses, midwives and doctors is recommended. (Recommended) RECOMMENDATION E.5.2: Task shifting the distribution of recommended nutritional supplements and intermittent preventive treatment in pregnancy (IPTp) for malaria prevention to a broad range of cadres, including auxiliary nurses, nurses, midwives and doctors is recommended. (Recommended) Remarks • Recommendations E.5.1 and E.5.2 have been adapted and integrated from Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting (OptimizeMNH) (2012) (201). • The GDG noted that, while task shifting has an important role to play in allowing flexibility in health-care delivery in low-resource settings, policy-makers need to work towards midwife-led care for all women. • Lay health workers need to be recognized and integrated into the system, and not be working alone, i.e. task shifting needs to occur within a team approach. • The mandate of all health workers involved in task shifting programmes needs to be clear. • In a separate guideline on HIV testing services (98), <strong>WHO</strong> recommends that lay providers who are trained and supervised can independently conduct safe and effective HIV testing using rapid tests (see Recommendation B.1.8). • The GDG noted that it may be feasible to task shift antenatal ultrasound to midwives with the appropriate training, staffing, mentoring and referral systems in place. • Further research is needed on the mechanism of effect of MLCC and whether continuity of care can be task shifted. • Further information on this recommendation can be found in the OptimizeMNH guideline (201), available at: http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/978924504843/en/ a Including promotion of the following: care-seeking behaviour and ANC utilization; birth preparedness and complication readiness; sleeping under insecticidetreated bednets; skilled care for childbirth; companionship in labour and childbirth; nutritional advice; nutritional supplements; HIV testing during pregnancy; exclusive breastfeeding; postnatal care and family planning; immunization according to national guidelines. Chapter 3. Evidence and <strong>recommendations</strong> 99
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WHO recommendations on antenatal care for a positive pregnancy experience

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