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Eight Antenatal Care Contacts: Why not the usual four visits?

The care provided by skilled healthcare providers to pregnant women and adolescent girls to ensure the best health conditions for both mother and baby during pregnancy is what constitutes antenatal care.
Antenatal care addresses four key areas. These include; nutritional interventions, maternal and fetal assessment, preventive measures, interventions for common physiological symptoms, and health systems interventions to improve the utilization and quality of antenatal care.

The updated Uganda Clinical Guidelines recommend eight antenatal care contacts at the very minimum, instead of the usual four health care providers previously advocated in the focused antenatal care since 1990. There are reasons why we shifted from four to eight, and why we want to phase out the term ‘visit’ and replace it with the term ‘contact’. Let’s look at a few of them below.

There has been a general observation through evidence-based practice that the four-visit focused antenatal care (FANC) model failed to offer adequate contact between the woman and her healthcare providers. As a reminder, during the usual four visits of FANC, the first one could happen before 12 weeks of gestation, the second one occurring around 26 weeks, third around 32 weeks and the fourth between 36 and 38 weeks. The clinicians then advised the mothers to return for antenatal care at 41 weeks of gestation or before if they experience any danger signs.

Related article: Antenatal corticosteroids for fetal organ maturation: latest recommendations.

During every antenatal visit, there are specific goals that aimed at improving triage and prompt referral of any woman that is high risk. There has been an association of more perinatal deaths in regions where focused antenatal care prevails than in those where models that have a minimum of eight visits.
When it comes to maternal satisfaction, evidence showed that women were more satisfied with more antenatal care contacts than with fewer visits.
Because of an active connection between the pregnant women and their healthcare providers, it’s more precise to term them ‘contact’ sessions rather than visits.

There has been evidence that we can improve safety during pregnancy through increasing the frequency of assessments of both the woman and her unborn child to detect problems.
Also, more antenatal care contacts can improve communication with the health system, as well as support during pregnancy for women and their families.

There was a suggestion of increasing the minimum contacts to be more than eight. However, evidence gathered from developed nations, showed no significant differences in maternal and perinatal outcomes between antenatal care centres providing at least eight contacts and those that have more.

Lastly, a positive pregnancy experience is likely to be achieved when there are more contacts between women and knowledgeable, supportive and respectful healthcare providers. We define a positive pregnancy experience as maintaining physical and sociocultural normality, maintaining a healthy pregnancy for the mother and the baby, having an efficacious transition to satisfying labour and birth, and achieving uneventful motherhood (this includes maternal self-esteem, competence, and autonomy).

In a nutshell, we all need to embrace this new development as we move towards achieving sustainable development goals by 2030. Don’t forget to share this article.


MBChB (MUK), Graduate Fellow, Department of Physiology, Makerere University Founder and Content Creator Peer reviewer, Associate Editor

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