Improving respectful maternity care through group antenatal care: Findings from a cluster randomized controlled trial

Disrespect and patient mistreatment have been cited as barriers to adherence and healthcare utilization, contributing to the slow progress in meeting maternal and child health targets, particularly in Ghana. Group antenatal care, an alternative to routine individualized care, is recommended by the World Health Organization as an effective service delivery model for low- and middle-income countries. This study examined the impact of group antenatal care on respectful maternity care compared to individual-based antenatal care, including mothers' perceptions of respectful care.

We conducted a cluster randomized controlled trial (RCT: NCT04033003) across 14 health facilities in the Eastern Region of Ghana from September 2018 to August 2024. Facilities were randomized using a matched-pairs design. Pregnant women were recruited using predetermined inclusion criteria with a total sample size of 1761. Written and verbal consent were obtained. Data on respectful maternity care-related outcomes were collected at time 2 (6 weeks postpartum). Data were analyzed on an intent-to-treat basis. Chi-square test was used to compare the outcome between the group antenatal (intervention) (n = 877) and individual (control) groups (n = 884). Results are reported individually as percentages with significance set at a p-value less than 0.05. Focus group discussions were conducted with women as part of a process evaluation. Content analysis was employed for the qualitative data.

Women in the group antenatal care reported greater respectful maternity outcomes than those in the control group (93.5 % vs. 83 %). A greater proportion (84 %) of midwives introduced themselves in the intervention group compared to 53 % in the control group. Waiting times were reduced (92 % vs. 81 %, p < 0.0001) in the intervention groups. Informed consent was also higher (95 % vs. 81 %). Women reported receiving information on nutrition (99.7 % vs. 94 %), what to expect during delivery (95 % vs. 87 %), delivery plans (99 % vs. 87 %), where to go to when complications arise (97 % vs. 94 %); breastfeeding (97 % vs. 81 %). Qualitative results indicated that group care ensured privacy and confidentiality, upheld dignity, was free from abuse and mistreatment, and generally contributed to satisfaction with group antenatal care.

Group antenatal care is an innovative strategy that promotes respectful maternity care, which is crucial for enhancing care quality and adherence among pregnant women. By improving respect in care through group antenatal care, we can address inequities, promote maternal health, and contribute to the achievement of Sustainable Development Goal 3 globally and in Ghana. These insights underscore the potential of group antenatal care as an impactful intervention to enhance respectful maternity care.