Introducing a group antenatal care model at the health post level in Ethiopia: a qualitative pilot study

Group antenatal care (G-ANC) is an alternative model of antenatal care that incorporates clinical assessment and care, participatory learning, and peer support. It gives expectant mothers the opportunity to discuss and share experiences with a group of women of similar gestational age throughout the pregnancy. This pilot study aimed to explore the feasibility of introducing a six-meeting G-ANC model in health posts, the most basic level of the health system in Ethiopia.

A qualitative study of G-ANC was conducted at five purposively selected health posts in two zones in the Amhara region of Ethiopia, involving 54 pregnant women aged 15 years and older with a gestational age of less than 20 weeks. Trained research staff moderated 13 in-depth and 7 key informant interviews that were conducted after the second of the six G-ANC meetings. All interviews and discussions were recorded with consent from participants. Transcribed interviews were translated and thematically analyzed using a framework with open code qualitative data analysis software aiding in data sorting, categorization, and coding.

An adequate number of pregnant women were identified early in pregnancy and recruited to form G-ANC groups for this study. Pregnant women were willing to be enrolled and participate in G-ANC meetings and indicated interest in attending future meetings. Health extension workers (HEWs) demonstrated the ability to facilitate G-ANC meetings effectively.

Introduction of G-ANC at the health post level appears feasible. None of the major anticipated feasibility challenges, adequate enrollment of eligible women, women's willingness to participate in successive meetings, and HEW capacity to facilitate, were encountered. Existing community structures were instrumental in achieving adequate enrollment. The training and G-ANC meeting guides enabled HEWs to effectively facilitate the meetings. Preliminary results from this pilot study informed the design of a stepped-wedge cluster randomized trial to evaluate the acceptability and effectiveness of G-ANC at the health post level on increased coverage of antenatal care and facility-based delivery.