Uptake of Group Antenatal and Postnatal Care Model and its effect on utilization of Maternal and Child Health Services among Pregnant and Breastfeeding Adolescent Girls and Young Women in Uganda. A retrospective descriptive study, 2021-2023
This retrospective study in Uganda (2021–2023) found that while the uptake of the Group Antenatal and Postnatal Care (G-ANC/PNC) model among adolescent girls and young women was low at 34%, participation in the model was significantly associated with improved utilization of maternal and child health services, including higher rates of facility delivery, postnatal care attendance, and contraceptive use, at a unit cost of $2.70 per beneficiary.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many parts of the world, the journey of pregnancy and early motherhood is fraught with obstacles, particularly for young women. When a girl or a young woman becomes pregnant, she faces a higher risk of serious health complications for herself and her baby compared to older mothers. These risks include dangerous conditions like high blood pressure during pregnancy, premature birth, and infants being born with low weight. Beyond the physical dangers, young mothers often struggle to navigate complex healthcare systems, missing critical checkups or failing to receive life-saving interventions like HIV testing or family planning advice. To address this, health experts have long sought ways to make care more welcoming and effective. One approach gaining traction is moving away from the traditional, solitary model of seeing a doctor alone in a quiet room. Instead, this method groups young mothers together, allowing them to receive care and education in a shared space. The idea is that by pooling their time and experiences, these women can learn from one another, feel less isolated, and stay engaged with their healthcare providers for longer.
In Uganda, where teenage pregnancy rates are among the highest in the region, the Ministry of Health decided to test this group-based approach on a large scale. They introduced a model where pregnant and breastfeeding young women, aged roughly 13 to 24, were organized into small cohorts of six to twelve people. These groups met for about two hours at a time, replacing the standard one-on-one appointments. During these sessions, trained health workers or peer educators led discussions, shared information, and provided psychological support, while still conducting necessary medical checks individually. The goal was to see if this communal style of care would encourage young women to visit the clinic more often, deliver their babies safely at a hospital, and continue care for their infants after birth. Researchers also wanted to understand how much this new system cost to run, ensuring that such a program could be sustained in a resource-limited setting.
To find the answers, a team of researchers from Makerere University, the Ugandan Ministry of Health, and the Centers for Disease Control and Prevention looked back at records from over two years, spanning from mid-2021 to the end of 2023. They examined data from 144 health facilities across the country. Half of these facilities were using the new group care model, while the other half continued with the standard, traditional way of treating patients. The researchers focused on a specific group of young women who had visited the clinic for their first prenatal checkup. They wanted to know two main things: how many young women actually chose to join the group sessions, and whether those who did join ended up using more health services than those who did not.
The study revealed that while the idea was sound, getting young women to sign up was difficult. Out of all the eligible young women who visited the clinics offering the group model, only about one-third actually enrolled. The uptake was even lower for women in their early twenties compared to teenagers, and it varied depending on whether the clinic was government-run or private, and whether it was a small health center or a large hospital. Despite this low enrollment, the results for those who did participate were striking. Young women in the group care model were nearly twice as likely to complete the recommended number of prenatal visits compared to their peers in the traditional system. They were also significantly more likely to get tested for HIV again during their pregnancy, a crucial step for preventing the virus from passing to the baby.
The benefits extended well beyond the pregnancy itself. Women in the group model were much more likely to give birth at the same health facility where they started their care, rather than traveling elsewhere or delivering at home. After the baby was born, these young mothers were far more likely to return for postnatal checkups at six weeks and again at six months. Perhaps most importantly, they were much more likely to adopt modern methods of birth control after delivery, which helps prevent another pregnancy too soon. The researchers calculated that for every young woman who benefited from this group care, the cost to the health system was approximately 2.70 US dollars. This figure included the salaries of staff, travel expenses, supplies, and the cost of the space used for the meetings.
The study did have some limitations. Because the researchers looked at old records rather than following women forward in time, they could not be certain that the group model caused every single improvement, as other factors like a woman's personal motivation or distance from the clinic might have played a role. Additionally, they could not track every single young woman if she moved to a different clinic, which might mean the true success rate was slightly higher than recorded. However, the data strongly suggests that when young women do engage with this group model, they receive better, more continuous care. The researchers concluded that while the model is effective, the challenge remains in getting more young women to join. They suggested that health programs could improve enrollment by integrating these group sessions into broader health education, involving male partners in the conversation, and ensuring clinics have enough space and resources to make the experience welcoming. The findings offer a clear path forward: the group care model works, but it needs to be made more accessible to truly transform maternal health for young women in Uganda.
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