Date Published: June 12, 2019
Publisher: Public Library of Science
Author(s): Marufa Sultana, Nausad Ali, Raisul Akram, Tania Jahir, Rashidul Alam Mahumud, Abdur Razzaque Sarker, Ziaul Islam, Yeetey Akpe Kwesi Enuameh.
Complications during pregnancy, childbirth, and following delivery remain significant challenges that contribute to maternal morbidity and mortality, thus affecting health systems worldwide. Group prenatal care (GPC) is an integrated approach incorporating peer support and health education that provides prenatal care in a group setting. The GPC approach was piloted in a district of Bangladesh to measure the feasibility and effectiveness of GPC compared to individual care. Understanding the experiences of women of receiving this grouped care approach is crucial to understand the perspectives, perception, and acceptability of the programme among mothers, which are lack in Bangladesh. The objective of the present study was to understand the core experiences and perspectives of mothers who participated in GPC sessions during their pregnancy period.
A qualitative research approach was used to understand the experiences of women receiving GPC. A total of 21 in-depth interviews were conducted in this study targeting pregnant mothers who attended all recommended GPC sessions. Face-to-face interviews were conducted by trained and experienced interviewers using a specific interview guideline to achieve detailed responses. Thematic analysis was conducted to analyse the data.
Mothers appreciated receiving pregnancy care in group setting and expressed their preferences towards GPC compared to individual care. Themes included the comprehensiveness of GPC, prescheduled appointments and reduced waiting time, social gathering, coping with common discomforts, relationship with service providers, birth preparedness, and recommendations from participating mothers. The themes conveyed overall positive experiences of the participating mothers, with suggestions for further betterment of the programme. Nevertheless, the reported experiences of women involved in the study suggests that the inclusion of a specialist in group care, post-partum care, and family planning advice will be more beneficial in the GPC model.
The overall experiences of the women in the present study suggest that GPC is helpful for them, and it is useful to reduce complications during pregnancy. The GPC model promises movement towards family-supported care, as explained by the participants.
Complications during pregnancy, childbirth, and following delivery remain significant challenges that contribute to maternal mortality and affect health systems worldwide . Maternal health care has been considered one of the key elements of the Millennium Development Goals (MDGs) and the more recent Sustainable Development Goals (SDGs), though progress on improving maternal health indicators remains slower than expected in many developing countries . According to the Bangladesh Maternal Mortality and Health Care Survey (BMMS), the estimated maternal mortality ratio (MMR) is 196/100,000 live births in 2016, which accounts for around 13% of total adult female deaths and has shown no significant change since 2010 . Notably, the majority of maternal and neonatal deaths were concentrated among the poor and in rural areas, and largely occurred due to lack of service availability, accessibility, affordability, or poor quality of services [2,4].
A qualitative research approach was used to understand the experiences of women using GPC. This approach provides more in-depth and circumstantial evidence  while providing a comprehensive summary of events in the usual language of the participants . As such, it enables us to explore the experience gained by pregnant women through participation in GPC sessions with other pregnant women, and to understand motivations for the utilisation of prenatal with postnatal care among them.
A total of 21 interviews were conducted up to data saturation with no refusal. Table 1 presents the basic demographic characteristics of the participants. The majority of interviewed women were aged between <20 and 24 years (62%), and eight women (38%) were experiencing their first pregnancy. All respondents had formal education, while most completed up to the secondary level education (n = 13). This qualitative study explored the overall experience of pregnant women participating in GPC sessions during their pregnancy period. The analysis identified several themes that expressed the experience of mothers from each aspect of attending GPC sessions. In particular, receiving all services at the same time, social interaction and sharing, reducing waiting time to receive service, friendly behaviour from service providers and other peers, knowledge about pregnancy related health issues with respective advice, and obtaining family support as a result of attending sessions were reported as the benefits of GPC from the attending mothers. Our study explored that pregnancy care in a group is well accepted and preferred by participating mothers in the context of Bangladesh. This approach provides an opportunity for pregnant women to become connected, to share knowledge and experiences, to reduce social isolation, and to learn about pregnancy-related issues in discussion sessions within a supportive environment. However, care should be tailored according to individual needs, whether it occurs in a group or through individual care. The GPC model promises movement towards peer- and family-supported care. The refinement and evaluation of this model should continue to improve the health outcomes of Bangladeshi women. Providers can use the findings of the present study to inform policy makers about the role of the GPC model in improving awareness as well as its impacts on improving female health and service utilisation efficiency. Finally, by addressing the maternal health goal, this study contributes to strengthening service delivery in our existing health care system. Source: http://doi.org/10.1371/journal.pone.0218169