Exploring solutions to improve antenatal care in resource-limited settings: an expert consultation

Abstract

Background Shortage or low-quality antenatal care is a complex and “wicked” problem relying heavily on contextual, socio-cultural, environmental and intersectional aspects. We report the outcome of an expert consultation discussing solutions to improve antenatal care quality, access and delivery in low- and middle-income countries, and providing recommendations for implementation. Methods The social ecological model was used as an analytical lens to map and interpret discussion points and proposed solutions. In addition, a conceptual framework for maternal and neonatal health innovation based on the building blocks of the World Health Organization health system and the Tanahashi Health Systems Performance Model provided a logical overview of discussed solutions. Results Many barriers and norms continue to hinder antenatal care access. From values, beliefs, traditions, customs and norms, to poor resource allocation, there is a need of reshaping health systems in order to provide high quality, respectful maternal and childcare. The burden of poor maternal health, morbidity and mortality is concentrated among populations who are vulnerable due to gender and other types of discrimination, have financial constraints and are affected by humanitarian crises. Conclusions In order to address maternal health issues, good quality and evidence-based services should be guaranteed. Investments in strengthening health systems, including data and surveillance systems and skilled health workforce, should be considered an essential step towards improving maternal health services.

Perspectives of women living with type 1 diabetes regarding preconception and antenatal care: A qualitative evidence synthesis

“…Although in a previous review Earle et al 25 explored views on the provision of, and facilitators of and barriers to the uptake of, preconception care through qualitative research, the present study is the first QES analyzing acceptability, feasibility and equity addressing a research gap. In a recent paper aimed at discussing solutions to improve antenatal care quality, access and delivery, the authors stated that more attention should be paid to a fuller understanding from the user's perspective, that should be inclusive, and that this could help to reduce some of the barriers to quality care 33 …”

“…In a recent paper aimed at discussing solutions to improve antenatal care quality, access and delivery, the authors stated that more attention should be paid to a fuller understanding from the user's perspective, that should be inclusive, and that this could help to reduce some of the barriers to quality care. 33 Experiences of care should be taken into account when developing CPGs and making evidence-based recommendations to support a better implementation of these recommendations. In this regard, a QES can provide decision-makers with additional evidence to improve their understanding of the complexity of the interventions, contextual variations and further understanding of values, attitudes and experiences of those who receive the interventions or who implement them.…”

Developmental origins of disease highlight the immediate need for expanded access to comprehensive prenatal care

“…), infrastructure critical to accessing health services (e.g., roads connecting rural and urban communities, affordable transportation, etc. ), and governmental investments to promote utilization (e.g., free maternal healthcare, primary resource allocation) could remove barriers to access for pregnant women ( 88 , 110 ). The Guttmacher institute estimates that increasing annual investment in LMICs by $4.80 per capita would close existing gaps in sexual and reproductive health services ( 108 ).…”

Effect of antenatal care on birth outcomes in The Gambia: a propensity score matching analysis

“…ANC also facilitates nutritional counseling and supplementation and educates expecting mothers about risk factors leading to neonatal complications. This comprehensive care model not only addresses immediate health concerns but also sets a foundation for long-term neonatal health, underscoring the critical role of consistent and quality ANC in resource-limited settings [19].…”