Feasibility, acceptability and effectiveness of group antenatal care on maternal health continuum of care and perinatal outcomes in sub-Saharan Africa: a systematic review and meta-analysis

BACKGROUND: Group antenatal care (G-ANC), integrating medical care with education, has demonstrated positive effects on maternal and newborn health. Individual studies have shown promising evidence in sub-Saharan Africa, but systematically synthesising the existing research would facilitate implementation and identify gaps for further research. This systematic review aimed, therefore, to review the existing evidence on feasibility, acceptability and effectiveness of G-ANC in resource-limited settings to guide policy and support implementing G-ANC to reduce maternal and perinatal mortality. METHODS: A systematic and comprehensive literature search was conducted in the PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase) and Google Scholar electronic databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses of healthcare interventions were followed. Data were extracted using a prespecified protocol and quality was assessed using the Joanna Briggs Institute appraisal tool. Random-effects meta-analyses were used to pool estimates. The review is registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024565501). RESULTS: Of the 576 articles identified, 34 articles with 42 234 participants were included. G-ANC increased the likelihood of attending four or more ANC visits (pooled risk ratio (RR)=1.45; 95% CI 1.22 to 2.82), was associated with the likelihood of attending postnatal care visits (RR=1.23; 95% CI 1.03 to 1.47), increased uptake of postpartum family planning methods (RR=1.85; 95% CI 1.26 to 2.73) and was associated with improved birth weight (RR=1.53; 95% CI 1.09 to 2.14). It was also associated with improved quality of care, health literacy, psychosocial gains, empowerment and facilitating culturally sensitive discussions. There was, however, no significant difference found between groups regarding likelihood of giving birth at health facilities compared with the traditional ANC. Also, no cost-effectiveness studies of G-ANC were identified in sub-Saharan Africa, highlighting a key evidence gap for guiding future implementation and scale-up. CONCLUSIONS: Exposure to G-ANC enhances utilisation of maternal healthcare such as ANC attendance, postnatal care, family planning uptake and improves birth weight. It also improves maternal engagement, health literacy and empowerment through a highly participatory learning approach and peer support. Nevertheless, no notable difference was observed between the groups in terms of likelihood of giving birth in health facilities. PROSPERO REGISTRATION NUMBER: CRD42024565501.