Evaluation of postnatal outcomes from a group antenatal care intervention in Nigeria: a quasi-experimental study

In previous studies in low- and middle-income countries (LMICs), group antenatal care (gANC) has been shown to increase health facility delivery and enhance the care experience for both women and providers. Here, we investigate whether those benefits lead to improvements in postnatal outcomes.

We examine three time points of data on participation in the gANC programme as an independent variable to predict postnatal mother and newborn health outcomes using multivariate analysis and propensity matching techniques. This approach aimed to isolate the causal effect of the number of gANC meetings attended on the probability of postnatal healthcare checks for the mother and infant, modern contraception utilisation, and breastfeeding. To achieve this, we used inverse-probability weighting in addition to adjusted multivariate logistic regression models.

We observed high retention at final follow-up and high attendance overall, with higher attendance associated with a variety of background and sociodemographic variables. Participants' attrition (under 24%) was well within power analysis assumptions. We found evidence of a strong positive relationship between greater gANC session attendance and mothers' postnatal health checks, breastfeeding initiation, and modern contraception utilisation. Adjustment for a set of sociodemographic and prior pregnancy- and delivery-related variables via inverse probability weighting suggested that a positive effect on these outcomes generally persists, especially at the highest levels of gANC session attendance.

The gANC programme at scale in Nigeria produced high levels of participation and resulted in positive postnatal outcomes among women who attended most of the meetings.