The introduction of group antenatal care in northern Nigeria: an implementation research study analysing changes in...

With one of the highest rates of maternal mortality in the world, improving antenatal care for the poorest communities is a high priority in Nigeria. In 2022, Project HOPE partnered with the Nigerian Ministry of Health to implement group antenatal care, a WHO-recommended health system strengthening intervention for improving pregnancy outcomes in Niger State.

The project trained 300 health workers and established group antenatal care in 150 health facilities. Training and initiation was staggered over September, October and November of 2022. Over 17 000 women participated in 1054 antenatal care groups from September 2022 to March 2023. We carried out an implementation research study to examine service utilisation rates and explore contributing factors within the project. Using an interrupted time series analysis, we examined project effects on antenatal contacts, facility births, live births, malaria positivity, postpartum contraception and postnatal care.

The analysis found statistically significant increases in first and fourth antenatal visits, facility births and live births following the intervention.

Despite significant challenges, including a shortened implementation period, the project increased service use. We assert that health system approaches were key influencing factors, such as the use of local master trainers, broad stakeholder engagement, strong monitoring and evaluation and the inclusion of the group antenatal care model in national guidelines. Noted challenges included inadequate skilled birth attendants and lack of antenatal care commodities, though stop gap measures addressed certain supply issues such as a lack of blood pressure cuffs.