About the Collaborative

It all started when…

The Global Group Antenatal Care Collaborative (the Collaborative) was conceived in October 2015 at the Global Maternal Neonatal Health conference in Mexico City by the organizers and participants of a panel on group care. The Collaborative was initially designed to connect researchers actively exploring group care models for the provision of antenatal care in low and middle-income countries (LMICs).  In March of 2016, Jhpiego hosted a 1-day meeting that officially established the Collaborative.

The primary goal of the Collaborative is to support an open forum where researchers can learn, share, and build partnerships in this emerging field and inform an active research agenda and prioritization. The specific goals of the Collaborative include, but are not limited to:

Defining:

• Group care (minimal necessary components)

• Key principles/best practices of group antenatal care

• A recommended minimum set of core indicators to track in research and implementation of GANC

Sharing and, as appropriate, disseminating relevant research study protocols, tools, and findings;

Identifying research gaps and opportunities; and

Advocating for group antenatal care at major conferences and other academic events

Who We Are | The Steering Committee

The Steering Committee is comprised of GANC researchers with active or recently published studies around the world. The purpose of the Steering Committee is to provide strategic leadership, manage Collaborative membership and identify and organize opportunities for communication among Collaborative members.

Jody R. Lori, Phd, CNM Chair (2021-2023)

Research Team | University of Michigan and Ghana Health Service | Dodowa Health Research Center | Cheryl Moyer, PhD | John Williams, PhD | Ruth Zielinski, PhD | Nancy Lockhart, MSN | Vida Kukula, MPH | Veronica Apetorgbor, MPH | Elizabeth Awini, PhD |Haiyan Liu, MS

New Avenues to Increase the Use of Skilled Birth Attendants in Ghana:  Fogarty International, National Institutes of Health, 1 K01 TW008763-01A1 (Dr. Jody R. Lori, PI) 2011-2016

A longitudinal, prospective, cohort design was used for this study.  Two hundred forty women were randomly assigned to group antenatal care (ANC) (n=120) or standard, individual care (n=120) at their first ANC visit.   The intervention group received ANC in a group format with 12 women grouped by gestational age.  The comparison group received the standard individualized focus ANC by the same group of providers.  Other than group vs. individual care, the two groups received identical antenatal treatment following the clinic guidelines. Women were followed from the time of entry into ANC enrollment through one-year postpartum.  Overall, there was a significant difference in the overall number of self-care measures identified among women attending group ANC vs. individual ANC (p=0.0001).  Participants receiving group ANC visits were more likely to have arrangements made in advance for emergency transportation should a problem occur (p=0.0004) and to have saved money in preparation for the delivery (p=<0.0001).  Women who participated in group ANC were more likely to use modern and non-modern contraception than those in individual care (59.1% vs. 19%, p < .001).  Women who participated in group ANC had higher odds of using a modern family planning method than those in individual care (OR=7.53, p<.001).  Those who participated in group ANC were more likely to exclusively breastfeed for more than 6 months than those in individual care (75.5% vs. 50%, p<.001).  In country partners included faculty from the University of Ghana and Kwame Nkrumah University of Science and Technology (KNUST).

Group Antenatal Care to Promote a Healthy Pregnancy and Optimize Maternal and Newborn Outcomes: A Cluster Randomized Controlled Trial:  Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), 1 R01 HD096277-01 (Dr. Jody R. Lori, PI) 2018-2023

Building upon favorable results from our Fogarty funded research, this study aims to improve health literacy, increase birth preparedness and complication readiness, and optimize maternal and newborn outcomes among women receiving group antenatal care (ANC).  Using a cluster randomized controlled trial stratified by site and gestational age as our study design, we will enroll 1690 women from 14 facilities in the Eastern Region of Ghana.  Data will be collected at five time points:  (1) enrollment into ANC; (2) third trimester; (3) post-delivery up to six weeks postpartum; (4) six months; and (5) one-year.  In-country partner is the Dodowa Health Research Center (DHRC). This study includes a unique process evaluation component, implemented concurrently, to identify and document patient, provider, and system barriers and facilitators to program implementation. Using both quantitative and qualitative methods, we will identify potential and actual influences on the quality and conduct of the program's operations, implementation, and service delivery.

Crystal L. Patil, PhD

Research Team | University of Illinois Chicago, University of Michigan | Kamuzu University of Health Sciences | Ellen Chirwa, PhD | Esnath Kapito, PhD | Kathleen Norr, PhD | Elizabeth T. Abrams, PhD | Kylea Liese, CNM PHD| Rohan Jeremiah, MPH | Dhruvi Patel, BS |

Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for 2/3 of new HIV infections and 1/4 of preterm births. Antenatal (prenatal) care is the entry point into the health system for many women and offers a unique opportunity to provide life-saving monitoring. However, provider shortages, low quality of care and failure to attend all recommended visits mean that the potential benefits of antenatal care are not realized. There is an urgent need to test novel interventions to reduce health risks for mother and child. Group antenatal care is a transformative model of care that provides a positive pregnancy experience, uses provider time efficiently, and improves perinatal and HIV-related outcomes. Women in group antenatal care have 2-hour visits with the same provider in a group of 8-12 women at a similar stage of pregnancy. Women conduct self-assessments, briefly consult the midwife, and meet for 80-90 minutes of interactive health promotion enlivened by games and role-plays. Women form relationships with midwives and each other. In a US randomized clinical trial (RCT), group care improved prematurity rates, antenatal care attendance, satisfaction with care, breastfeeding practices, safer sex behaviors, and uptake of family planning. Our randomized pilot in Malawi and Tanzania had promising outcomes. More women in group care than in usual care completed ≥4 antenatal visits (94% vs 58%). Their partners were more likely to be tested for HIV during pregnancy (51% vs. 27%). We established that group antenatal care can be offered in a rigorous RCT with high fidelity despite provider shortages. The next step is an adequately powered effectiveness trial. Malawi is an especially appropriate site because it has the world's highest prematurity rate (18%) and high HIV prevalence (10% nationally, 16% at the study site). We use a hybrid design to simultaneously conduct an effectiveness RCT with individual-level randomization and examine implementation processes at 6 clinics in Blantyre District, Malawi. Aim 1 is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that compared to usual care, women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We test Aim 1 hypotheses using multi-level hierarchical models using data from repeated surveys and health records. Aim 2 is to identify clinic-level degree of implementation success and contextual factors associated with success for each clinic and across clinics. Analyses use within and across-case matrices. This high-impact study addresses three global health priorities, maternal and infant mortality and HIV prevention, that affect all women of childbearing age in Malawi. The Ministry of Health strongly supports this project; results will help them decide whether to scale-up this innovative model of group care. Negative results will avoid spending on ineffective care. Positive results will provide evidence needed to adopt group antenatal care nationally and in other low-resource countries.