Bibliographic Info
GuidelineWHO recommendations on antenatal care for a positive pregnancy experience
Year of Publication2016
Issuing InstitutionWHO
Recommendation
Status
Updated
Recommended
Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care
Notes and Remarks
- 1.The GDG stresses that the four-visit focused ANC (FANC) model does not offer women adequate contact with health-care practitioners and is no longer recommended. With the FANC model, the first ANC visit occurs before 12 weeks of pregnancy, the second around 26 weeks, the third around 32 weeks, and the fourth between 36 and 38 weeks of gestation. Thereafter, women are advised to return to ANC at 41 weeks of gestation or sooner if they experience danger signs. Each ANC visit involves specific goals aimed at improving triage and timely referral of high-risk women and includes educational components. However, up-to-date evidence shows that the FANC model, which was developed in the 1990s, is probably associated with more perinatal deaths than models that comprise at least eight ANC visits. Furthermore, evidence suggests that more ANC visits, irrespective of the resource setting, is probably associated with greater maternal satisfaction than less ANC visits.
- 2.The GDG prefers the word “contact” to “visit”, as it implies an active connection between a pregnant woman and a health-care provider that is not implicit with the word “visit”. In terms of the operationalization of this recommendation, “contact” can be adapted to local contexts through community outreach programmes and lay health worker involvement.
- 3.The decision regarding the number of contacts with a health system was also influenced by the following:
- – evidence supporting improving safety during pregnancy through increased frequency of maternal and fetal assessment to detect problems;
- – evidence supporting improving health system communication and support around pregnancy for women and families;
- – evidence from HIC studies indicating no important differences in maternal and perinatal health outcomes between ANC models that included at least eight contacts and ANC models that included more (11–15) contacts;
- – evidence indicating that more contact between pregnant women and knowledgeable, supportive and respectful health-care practitioners is more likely to lead to a positive pregnancy experience.
- 4.Implementation considerations related to this recommendation and the mapping of guideline recommendations to ANC contacts are presented in Chapter 4 on the full guideline