Group Antenatal Care: The Power of Peers for Increasing Skilled Birth Attendance in Achham, Nepal
Condition: Prenatal Care
Study type: Interventional

Summary: 
      In rural Nepal, the major drivers of underutilization of skilled birth attendance are
      poverty, poor social support and inadequate birth planning. Drawing from similar programs
      that have been shown to improve maternal and neonatal outcomes, we have designed a group
      antenatal care program that uses a participatory learning and action process to engage women
      in identifying and solving problems accessing maternity care services and create a supportive
      social network. We plan to test a group antenatal care program that will change antenatal
      care in three major ways: 1) conduct care in a group setting with women matched by
      gestational age, 2) incorporate participatory learning and action, and 3) provide expert and
      facilitated peer counseling.
    

Detailed description: 
      The group antenatal care intervention aims to improve rates of institutional birth and ANC
      care completion via improving acceptability of group care, maternal and neonatal health
      knowledge, self-efficacy, social support, and birth planning.

      Objective 1: Assess the effect of group antenatal care on institutional birth rates through a
      prospective study using community household census data. Secondary outcomes will be
      completion of basic ANC package; neonatal mortality rate; percentage of preterm births;
      percentage of stillbirths; and percentage of small-for-gestational age (SGA) births.

        -  Hypothesis 1: Group ANC will increase institutional birth rates by 5% over one year.

        -  Hypothesis 2: Group ANC will increase completion of 4 ANC visits by 5% over one year.

        -  Hypothesis 3: Group ANC will reduce infant mortality rate by 5% over one year.

        -  Hypothesis 4: Group ANC will reduce the postpartum contraceptive prevalence rate by 5%
           over one year.

        -  Hypothesis 5: Group ANC will reduce the stillbirth rate by 5% over one year.

        -  Hypothesis 6: Group ANC will reduce the perinatal mortality rate 5% over one year.

        -  Hypothesis 7: Group ANC will reduce the combined infant mortality and stillbirth rate by
           5% over one year.

      Objective 2: Assess the mechanisms of implementation of group antenatal care through
      quantitative participant survey measures, qualitative focus group discussions and key
      informant interviews.

        -  Hypothesis 1: Group antenatal care will be acceptable to participants and providers, and
           preferred to individual care.

        -  Hypothesis 2: Group antenatal care will increase pregnant patients' access to and
           utilization of delivery services through improved knowledge, self-efficacy, social
           support and birth planning.

      Objective 3: Report on key aspects of the implementation process: costs, human resources,
      logistics, and fidelity of the group antenatal program to model content and participatory
      processes.
    

Intervention name(s): Group Antenatal Care; Individual Antenatal Care
Intervention type(s): Other; Other
Intervention description(s): The group antenatal care intervention will match pregnant women by gestational age in the intervention village clusters and assign them to peer group sessions facilitated by local healthcare clinic staff.; Pregnant women in control village clusters will have individual antenatal care sessions with their healthcare provider.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Maternal Mortality; Institutional Birth Rate; Neonatal Mortality Rate; Preterm Birth; Stillbirth; Infant, Small for Gestational Age; Nepal; Implementation Research; Global Health