Group Antenatal Care and Maternal and Perinatal Outcomes in Africa: A Meta-analysis

This systematic review and meta-analysis examined the feasibility, acceptability, and effectiveness of Group Antenatal Care (G-ANC) in improving maternal healthcare utilisation and perinatal outcomes across sub-Saharan Africa.

The review included 34 studies involving 42,234 participants from eight countries in sub-Saharan Africa. The studies, published between 2016 and 2025, included randomised controlled trials, cohort studies, quasi-experimental studies, mixed-methods research, and qualitative studies.

The researchers systematically searched major scientific databases and synthesised both quantitative and qualitative evidence. Meta-analysis was used to assess the effect of G-ANC on antenatal care attendance, facility-based delivery, postnatal care, postpartum family planning, and birth outcomes. Qualitative evidence was also reviewed to understand the model's feasibility, acceptability, cultural appropriateness, and wider psychosocial benefits.

Group Antenatal Care typically brought together women at similar stages of pregnancy for scheduled sessions combining routine clinical assessment, participatory health education, self-care activities, peer support, and facilitated discussion. This approach was compared with conventional individual antenatal care.

The review found that Group Antenatal Care significantly improved several important components of the maternal health continuum of care.

Women participating in G-ANC were 45% more likely to attend four or more antenatal care visits compared with women receiving conventional individual care (RR=1.45; 95% CI 1.22–1.73).

G-ANC participants were also 23% more likely to attend postnatal care after delivery (RR=1.23; 95% CI 1.03–1.47).

One of the strongest effects was seen in postpartum family planning. Women participating in G-ANC were 85% more likely to use a postpartum family planning method compared with those receiving conventional antenatal care (RR=1.85; 95% CI 1.26–2.73).

The review also found evidence of improved birth weight outcomes among babies born to women who participated in G-ANC (RR=1.53; 95% CI 1.09–2.14). However, this finding was based on a relatively small number of studies and should therefore be interpreted with caution.

In contrast, there was no statistically significant difference in facility-based delivery between women receiving G-ANC and those receiving conventional antenatal care (RR=1.23; 95% CI 0.96–1.57).

Beyond clinical and service utilisation outcomes, G-ANC was associated with important improvements in health literacy, recognition of pregnancy danger signs, birth preparedness, self-efficacy, empowerment, and maternal engagement in care.

Women also benefited from stronger peer relationships and social support. Group sessions created opportunities for women to share experiences, reduce pregnancy-related fears, build supportive networks, and improve communication with healthcare providers and other women.

The model also provided a supportive environment for discussing sensitive health and social issues, including HIV prevention, partner testing, reproductive health, intimate partner violence, and personal safety. The evidence suggested that G-ANC could be particularly valuable for adolescents, young women, and other vulnerable populations.

Overall, the evidence indicated that G-ANC is both feasible and acceptable in resource-constrained settings. Recruitment and retention of pregnant women were generally high, with reported participation and retention rates ranging from approximately 70% to 95%.

Women, healthcare providers, and community health workers generally viewed the model positively. Many healthcare providers reported improved relationships with women and greater satisfaction with the interactive approach to care.

However, successful implementation requires important changes to routine service delivery. Key challenges included staff shortages, high healthcare worker workloads, inadequate space for group sessions, limited numbers of trained facilitators, privacy concerns, transport barriers, cultural hesitancy, and insufficient resources.

The review highlighted the need for continuous facilitator training and mentorship, adequate infrastructure, stronger community partnerships, mechanisms to protect confidentiality, and supportive health system policies.

Importantly, the review found no cost-effectiveness studies of G-ANC in sub-Saharan Africa. This represents a major evidence gap for governments and health systems considering large-scale implementation.

This systematic review and meta-analysis provides strong evidence that Group Antenatal Care can improve the use of essential maternal health services in sub-Saharan Africa.

Compared with conventional individual antenatal care, G-ANC was associated with higher antenatal care attendance, greater use of postnatal care, increased uptake of postpartum family planning, and improved birth weight outcomes. It also provided important non-clinical benefits, including greater health literacy, empowerment, peer support, social connectedness, and improved relationships between women and healthcare providers.

However, G-ANC did not significantly increase facility-based delivery, suggesting that improvements in knowledge, engagement, and antenatal care attendance alone may not overcome broader barriers such as distance, infrastructure limitations, cultural norms, and weaknesses in health systems.

The findings support the integration of G-ANC into maternal health services in sub-Saharan Africa, but successful scale-up will require context-specific adaptation, investment in healthcare worker training, adequate resources, supportive infrastructure, and stronger links with communities.

Future research should focus on cost-effectiveness, long-term maternal and newborn outcomes, implementation at scale, equity, health system effects, and the optimal intensity of G-ANC for high-risk populations.