1. Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Maternal and Newborn Health Training Package Session 4: Pregnancy and Antenatal Care

2. Antenatal care (ANC) and its importance  25% of maternal deaths occur during pregnancy  Caring for newborns starts with caring for pregnant mothers  Good care during pregnancy is important for the health of the mother & unborn baby and results in better pregnancy outcomes for both

3. ANC on the MNH continuum of care

4. At least 4 focused ANC visits  Minimum of 4 ANC visits – Before 16 weeks, between 24 and 28 weeks, at 32 weeks, and at 36 weeks  PSA from Zambia on importance of ANC (optional) (http://www.thehealthcompass.org/sites/default/files/project_examples/Safe%20 Motherhood%20-%20Antenatal.mp3)http://www.thehealthcompass.org/sites/default/files/project_examples/Safe%20 Motherhood%20-%20Antenatal.mp3  Quality of ANC visits – Number of visits – Timing of first visit – Inclusion of all recommended care interventions

5. (Post adaptation) [Share national protocols and policies for focused ANC visits during pregnancy, including the number and schedule of visits, where these take place, and with what kinds of trained health providers (doctors, nurses, midwives, auxiliary health workers, MCH workers, CHWs, or others).]

6. Focused ANC visits: 4 categories of care  Screening for health conditions and diseases  Detection and management of complications related to pregnancy  Health promotion and disease prevention measures  Advice and support to the woman and her family regarding healthy home behaviors and a birth and emergency preparedness plan

7. Focused ANC visits: Global progress and coverage  Proportion of pregnant women in developing countries attending at least 4 ANC visits: 37% in 1990 to 50% in 2011  In low-income countries, however, only 37% attended 4+ ANC visits during 2005–2012  Many wait to start ANC until second or even third trimester of pregnancy  Within countries, profound socioeconomic disparities for ANC visits

8. Barriers and enabling factors affecting ANC visits  Demand: for education, beliefs, social norms, high birth parity  Access: distance to facility, cost of travel, opportunity costs when waits are long  Quality of services: opportunity costs to woman when waits are long, facility resource constraints, supply issues, disrespectful treatment of women by service providers  Enabling factors: referrals by trained traditional birth attendants

9. Healthy home behaviors during pregnancy  Signs of pregnancy, importance and timeliness of ANC visits  Danger signs of pregnancy requiring emergency care  Daily rest, decreased workload  Prevent infectious diseases  Practice of safer sex using condoms  Seek counseling and testing services for HIV/AIDS and TB; access to care and treatment  Avoid use of tobacco and alcohol  Make a birth and emergency plan  Learn about early and exclusive breastfeeding  Plan for birth spacing after delivery

10. Nutrition education and counseling during pregnancy  Healthy home behaviors include good nutrition! – More food – additional meal or snacks – Varied food – including animal products, fruits, and vegetables – Micronutrients – supplements such as iron folate or vitamin A; fortified foods with iron, iodine, folic acid, vitamin A; use of iodized salt