Some Evidence from Research Conducted in Low-and Middle-Income Countries (LMICs)

Coverage: GANC is associated with increased ANC coverage (7/9 settings)

At least four ANC visits (ANC4+) (5/7 settings): Nigeria (Grenier et al. 2019) 91.0% vs. 42.3%, aOR 13.30 (7.69–22.99), p<0.001; Kenya (Grenier et al. 2019) 88.2% vs. 50.1%, aOR 7.12 (3.91–12.97), p<0.001; Malawi and Tanzania (Patil et al. 2017a) 94.1% vs. 58.2%, p<0.001 and significant for each country separately; Senegal (McKinnon et al. 2020) 82% vs. 69%, ARR=1.18 (1.07–1.29); Nepal (Thapa et al. 2019) not significant (N/S)

At least six ANC visits (ANC6+) (2/2 settings): Nigeria (Grenier et al. 2019) 59.6% vs. 11.2%, aOR 10.81 (5.87–19.92), p<0.001; Kenya (Grenier et al. 2019) 50.4% vs. 12.2%, aOR 8.27 (4.32–15.82), p<0.001

Higher mean/median number of ANC visits (3/3 settings): Ghana (Lori et al. 2017) mean 7.4 vs. 6.4, p<0.01; Nigeria (Grenier et al. 2019) median 6 vs. 3, p<0.001; Kenya (Grenier et al. 2019) median 6 vs. 4, p<0.001

Attended ANC at least once in second and third trimester (0/1 setting): Nigeria (Eluwa et al. 2018) N/S

Adequate ANC* (1/1 setting): Iran (Jafari et al. 2010b) 66.3% vs. 36.7%, p<0.001, OR 1.35 (1.26‒1.44)

Quality: provision of care - GANC is associated with improved quality of care, especially comprehensiveness of counseling/education (5/6 settings)

Overall quality of ANC, composite (2/2 settings): Nigeria (Grenier et al. 2019) 43.1% vs. 9.1%, aOR 5.8 (1.98–17.21), p<0.001; Kenya (Grenier et al. 2019) 32.3% vs. 8.3%, aOR 5.08 (2.31–11.16), p<0.001

Counseling/education during ANC, composite (5/5 settings): Ghana (Lori et al. 2017) six of nine topics, p<0.01; Nigeria (Grenier et al. 2019) all 12 topics, 85.5% vs. 34.1%, aOR 8.20 (2.63–25.71), p<0.001; Kenya (Grenier et al. 2019) all 12 topics, 67.0% vs. 21.7%, aOR 7.86 (3.65–16.92), p<0.001; Iran (Jafari et al. 2010b) each of eight topics, p<0.001 (no composite); Senegal (McKinnon et al. 2020) each of 12 topics (no composite)**

IPTp mean number of doses (2/2 settings): Nigeria (Noguchi et al. 2020) 3.45 [SD 1.53] vs. 2.14 [SD 1.55], p<0.001; Kenya (Noguchi et al. 2020) 3.81 [2.35] vs. 2.72 [1.65], p=0.001

IPTp2+ (1/2 settings) and not significant for IPTp3+ (0/2 settings): Nigeria (Noguchi et al. 2020) IPTp2+ 91.6% vs. 60.6%, p<0.001, IPTp4+ 52.6% vs. 16.3%, p=0.004, IPTp5+ 29.6% vs. 8.5%, p=0.034; Kenya (Noguchi et al. 2020) IPTp5+ 46.0% vs. 13.0%, p<0.001

Danger signs assessed at every ANC visit (2/2 settings): Nigeria (Grenier et al. 2019) 90.0% vs. 58.1%, aOR 5.67 (2.06–15.62), p<0.001; Kenya (Grenier et al. 2019) 87.2% vs. 66.9%, aOR 2.87 (1.10–7.53), p=0.032

Tetanus toxoid (0/2 settings): Nigeria (Eluwa et al. 2018) N/S; Senegal (McKinnon et al. 2020) received at least two doses during pregnancy, N/S

Quality: Experience of care - GANC is associated with greater satisfaction compared to usual/individual care (6/6 settings)

Satisfaction (5/5 settings): Malawi and Tanzania (Patil et al. 2017a) G-ANC (39.2 ± 6.7) vs. individual ANC (27.7 ± 6.6), difference 11.56, p<0.001; Iran (Jafari et al. 2010b) 22 of 24 questions, p<.0001; Nigeria (Adaji et al. 2019) 4 of 5 questions, p<0.01 with one question p=0.036; Nepal (Thapa et al. 2019) ANC level of enjoyment, 84% vs 60%, p=0.01 (note N/S for quality of ANC sessions or quality of ANC provider)

Preference for G-ANC (1/1 setting): Senegal (McKinnon et al. 2020) 95% would choose G-ANC if pregnant again.

quality: experience of care for providers - providers prefer offer group care care over individual care (2/2 settings)

Preference for G-ANC (2/2 settings): Rwanda (Lundeen et al. 2019) 86% of providers preferred group ANC and PNC; Senegal (McKinnon et al. 2020) 91.7% preferred G-ANC

Job satisfaction (0/1 setting): Rwanda (Lundeen et al. 2019) N/S

Perceived stress scale (0/1 setting): Rwanda (Lundeen et al. 2019) N/S difference between arms, N/S from baseline and followup

health literacy: pregnancy and childbirth - ganc is ASSOCIATED with improved knowledge of danger signs in pregnancy (6/6 settings)

Danger signs in pregnancy, composite (3/3 settings): Senegal (McKinnon et al. 2020) knowledge of at least three pregnancy-related danger signs (58% vs. 9%); Nepal (Thapa et al. 2019) knowledge of key pregnancy danger signs significantly improved at endline in the intervention clusters (2% to 31%, p<0.001) and between arms at endline (31% vs. 10%, p=0.01); Nigeria (Adaji et al. 2019) knowledge of at least five of eight danger signs increased from 1.4% to 13.3%, p<0.001 (4.28–19.52) and mean knowledge score increased from 31.0% to 47.8%, p<0.001 (0.86–2.16)

Danger sign: Pain in breast or abdomen (1/1 setting): Ghana (Lori et al. 2017) 46.0% vs. 28.9%, p=0.02

Danger sign: Headache/blurred vision (2/2 settings): Ghana (Lori et al. 2017) 91.0% vs. 77.1%, p=0.01; Nigeria (Adaji et al. 2019) bad headache 33.3% increased to 53.3%, p=0.002; Nigeria (Adaji et al. 2019) blurred vision 2.8% increased to 21.1%, p<0.001

Danger signs in childbirth (0/1 setting): Nepal (Thapa et al. 2019) N/S

HIV knowledge (2/2 settings): Malawi and Tanzania (Patil et al. 2017a) 84.8% vs. 56.9%, OR 4.59 (1.72–12.25), p=0.002

PMTCT knowledge (2/2 settings): Malawi and Tanzania (Patil et al. 2017a) 75.0% vs 54.1%, OR 3.52 (1.29–9.64), p=0.014

self-efficacy and empowerment (2/3 settings)

Pregnancy-related empowerment scale (PRES) (2/3 settings): Malawi (Patil et al. 2017b) higher overall PRES score for G-ANC and on every item, type of care was the strongest statistically significant predictor; Senegal (McKinnon et al. 2020) 77% vs. 13%, agreeing with all items related to skillful decision-making, provider connectedness, and gaining voice; Tanzania (Patil et al. 2017b) N/S overall but three items related to provider connectedness were significantly different; Muslim women scored lower on PRES than Christian women but when receiving G-ANC, scores were similar in both groups.

General self-efficacy (1/1 setting): Senegal (McKinnon et al. 2020) 17.8 vs. 16.6, risk difference 1.2, ARR 1.07 (1.03–1.11)

uptake of key behaviors: pregnancy/birth - ganc is associated with birth planning and inten to use postpartum family planning (5/6 settings)

Completed a set of birth-planning actions (3/4 settings): Nigeria (Grenier et al. 2019) completed all seven actions 76.3% vs. 38.0%, aOR 4.49 (1.52–13.32), p<0.001; Kenya (Grenier et al. 2019) 76.6% vs. 53.3%, aOR 2.86 (1.11–7.38), p=0.030; Senegal (McKinnon et al. 2020) completed all five actions 84% vs 6%; Nepal (Thapa et al. 2019) completed three actions N/S

Arranged emergency transport (3/4 settings): Ghana (Lori et al. 2017) 98.0% vs. 83.1%, p=0.01; Nigeria (Grenier et al. 2019) 89.6% vs. 63.6%, aOR 4.23 (1.77–10.12), p=0.001; Kenya (Grenier et al. 2019) 92.8% vs. 81.8%, 2.70 (1.22–5.94), p=0.014; Nepal (Thapa et al. 2019) N/S

Saved/arranged money (2/4 settings): Ghana (Lori et al. 2017) 99% vs. 80.7%, p<0.01; Nigeria (Grenier et al. 2019) 93.5 vs. 80.1%, 3.27 (1.48–7.23), p=0.003; Kenya (Grenier et al. 2019) N/S; Nepal (Thapa et al. 2019) N/S

Intention to use family planning (1/1 setting): Ghana (Lori et al. 2017) 63.0% vs. 31.6%, p<0.01

Better iron and folic acid supplementation adherence (2/4 settings): Iran (Jafari et al. 2010a) taking iron supplement 91.6% vs. 79.2%, p=0.001, cluster-adjusted OR 2.84 (1.98–4.09); Nigeria (Grenier et al. 2019) never ran out 87.6% vs. 70.3%, aOR 3.25 (1.31–8.06), p=0.011; Kenya (Grenier et al. 2019) N/S; Senegal (McKinnon et al. 2020) short on iron and folic acid during pregnancy N/S

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Title | Group Antenatal Care: The Power of Peers for Increasing Skilled Birth Attendance in Achham, Nepal

Organization: Brigham and Women's Hospital, Possible, University of Washington

PI/First Author: Duncan Maru

Status: Completed, results published 2016

Title | HIV With Innovative Group Antenatal Care in Two African Countries

Organization: University of Illinois Chicago

PI/First Author: Crystal L. Patil

Status: Completed, results published 2016

Title | AfyaJamii (Parenting Well): Evaluating the Feasibility of a Group Antenatal/Well-child Care Model in Pregnancy in Kenya

Organization: Moi University, Grand Challenges Canada, GOK

PI/First Author: Julia Songok

Status: Completed, results published 2014

Title | Centeringpregnancy-Africa: a pilot of group antenatal care to address millennium development goals

Organization: University of Illinois Chicago; University of Malawi

PI/First Author: Crystal Patil

Status: Completed, results published 2013

Title | Comparison of Maternal and Neonatal Outcomes of Group Versus Individual Prenatal Care

Organization: Tehran University

PI/First Author: Fatemeh Jafari

Status: Completed, published 2010

Title | Realist review of theories of effect of group care

Organization: University of East London; City, University of London; REACH Pregnancy Programme

PI/First Author: Giordana Da Motta

Status: In Submission

Title | A realist review of group antenatal care to improve women's experiences of care and birthing outcomes.

Organization: REACH Pregnancy Programme

PI/First Author: Penny Haora

Status: PROSPERO CRD42016036768; Published 2016

Studies in Progress

Title | Influence of Prenatal education classes on quality of life of pregnant women

Organization: Islamic Azad University Tonekabon Branch

PI/First Author: Rahimiyan Nasrin

Status: Not recruiting, completion to be confirmed (IRCT2017012732228N1)

Title | The impact of educational prenatal care by two methods support group and individual-centered on the satisfaction and empowerment in pregnant women

Organization: Tehran University

PI/First Author: Fereshteh Jahdi

Status: Not recruiting, completion to be confirmed (IRCT201307222248N11)

Title | Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

Organization: Possible

PI/First Author: PI - Sheela Maru, MD, MPH; First author - Poshan Thapa

Status: Under Review

Title | Group Antenatal Care: Effectiveness and Contextual Factors Linked to Implementation Success in Malawi

Organization: University of Illinois Chicago

PI/First Author: Crystal L. Patil

Status: In progress

Title | Group Antenatal Care to Promote a Healthy Pregnancy and Optimize Maternal and Newborn Outcomes: A Cluster Randomized Controlled Trial

Organization: University of Michigan and Ghana Health Service, Dodowa Health Research Center

PI/First Author: Jody R. Lori

Status: Recruitment starting June 2019 (R01HD096277)

Title | Assessing the Impact of Group Antenatal Care on IPTp Uptake in Tanzania (GANC-TZ)

Organization: Jhpiego, Ministry of Health Tanzania

PI/First Author: Ruth Lemwayi

Status: Not yet recruiting

Title | Antenatal Care/Postnatal Care (ANC/PNC) Innovations and Implementation Research Platform (ANC/PNC Collective)

Organization: Jhpiego; Harvard School of Public Health; Child Health and Mortality Prevention Surveillance (CHAMPS); RTI International; Christian Medical College Vellore; DAI; the World Health Organization; CARE/India; the University of Manitoba; Johns Hopkins School of Public Health

Status: Ongoing

Title | systematic reviews of literature on women’s satisfaction with care

Organization: GC 1000 (Group Care 1000)

PI/First Author: Ilir Hoxha

Status: Ongoing

Title | What are the experiences of women accessing group care in different contexts?

Organization: GC 1000 (Group Care 1000)

PI/First Author: Anna Horn

Status: Ongoing; PROSPERO CRD42021248227, 2021

Title | systematic review of literature on eConomics of group care

Organization: GC 1000 (Group Care 1000)

PI/First Author: Den Akker

Status: In Development

Briefs and Case Studies

Title | Group antenatal care: building the evidence base for g-ANC in Low-Resource Settings

Research Brief: Findings from published research on G-ANC in 9 low and middle-income countries

Organization: Jhpiego and ANC PNC Research Collective