Integrated Person-Centered Health Care for All Women During Pregnancy: Implementing World Health Organization Recommendations on Antenatal Care for a Positive Pregnancy Experience

Sarah de Masi; Maurice Bucagu; Özge Tunçalp; Juan Pablo Peña-Rosas; Theresa Lawrie; Olufemi T Oladapo; Metin Gülmezoglu

doi:10.9745/GHSP-D-17-00141

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TABLE. Health Systems Interventions to Improve the Use and Quality of Antenatal Care as Recommended by the 2016 WHO Guideline on Routine Antenatal Care⁵

Recommended Interventions	Description
Midwife-led continuity of care	Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum, and postnatal continuum, are recommended for pregnant women in settings with well-functioning midwifery programs.
Group antenatal care	Group antenatal care provided by qualified health care professionals may be offered as an alternative to individual antenatal care for pregnant women in the context of rigorous research, depending on a woman's preferences and provided that the infrastructure and resources for delivery of group antenatal care are available.
Task shifting components of antenatal care delivery^a	Task shifting the promotion of health-related behaviors for maternal and newborn health^b to a broad range of cadres, including lay health workers, auxiliary nurses, nurses, midwives, and doctors, is recommended.
Task shifting components of antenatal care delivery^a	Task shifting the distribution of recommended nutritional supplements and intermittent preventive treatment in pregnancy for malaria prevention to a broad range of cadres, including auxiliary nurses, nurses, midwives, and doctors, is recommended.
Recruitment and retention of staff in rural and remote areas^c	Policymakers should consider educational, regulatory, financial, and personal and professional support interventions to recruit and retain qualified health workers in rural and remote areas.
Community-based interventions to improve communication and support	The implementation of community mobilization through facilitated participatory learning and action cycles with women's groups is recommended to improve maternal and newborn health, particularly in rural settings with low access to health services.^d Participatory women's groups represent an opportunity for women to discuss their needs during pregnancy, including barriers to reaching care, and to increase support to pregnant women.
	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.
Women-held case notes	It is recommended that each pregnant woman carries her own case notes during pregnancy to improve continuity, quality of care, and her pregnancy experience.
Antenatal care contact schedules	Antenatal care models with a minimum of 8 contacts are recommended to reduce perinatal mortality and improve women's experience of care.

↵a Recommendations adapted and integrated from WHO (2012).⁷
↵b Including promotion of the following: care-seeking behavior and antenatal care utilization, birth preparedness and complication readiness, sleeping under insecticide-treated bed nets, skilled care for childbirth, companionship in labor and childbirth, nutritional advice, nutritional supplements, other context-specific supplements and interventions, HIV testing during pregnancy, exclusive breastfeeding, postnatal care and family planning, and immunization according to national guidelines.
↵c Recommendation adapted and integrated from WHO (2010).⁸
↵d Integrated from WHO (2014).⁹