Antenatal Care Module: 2. Promoting Antenatal Care

Study Session 2 Promoting Antenatal Care

Introduction

In this study session you will learn the difference between health promotion, health education, health screening and disease prevention, and learn about different methods of communicating health education messages respectfully and compassionately.

You will also learn how to educate and engage individuals, groups, opinion leaders and community members in the promotion and better utilisation of antenatal care services. Exactly the same principles apply to promoting the uptake of health services for labour and delivery, and postnatal care — as you will see in the next two Modules. Finally, we show you the steps in planning health education activities aimed at reducing maternal and newborn mortality by increasing the antenatal care coverage rate. You can apply these same steps to health promotion activities with other aims, for example increasing the uptake of family planning services.

Learning Outcomes for Study Session 2

When you have studied this session, you should be able to:

2.1 Define and use correctly all of the key words printed in bold. (SAQ 2.1)

2.2 Discuss the benefits of promoting the antenatal care service in your community. (SAQ 2.2)

2.3 Describe different methods of promoting antenatal care, including through advocacy and social mobilisation, health campaigns, community events, group and individual discussions. (SAQ 2.3)

2.4 Describe the steps in organising a health education event to promote the utilisation of antenatal care services in your catchment area. (SAQ 2.3)

2.1 Health promotion

Health promotion refers to any activities that result in better health in a community or a country. It includes the process of enabling people to increase control over, and to improve, their own health, but it moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions that increase health and wellbeing. Health promotion includes any actions of individuals, community organisations, district and regional health bureaus, and governments, aimed at improving the health of their population. For example, building more hospitals and health centres, and training more health workers, is a ‘health promoting’ activity at the national level. So too is ensuring that everyone in the population has access to enough food, shelter and clean water.

Health promotion at the community level includes three types of activities (Figure 2.1). We will begin by looking at examples of each of these in turn.

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Figure 2.1 Health promotion at the community level includes health education, health screening and disease prevention activities.

Health education is the effective transmission of accurate, useful, health-related information to community members; it enables individuals and groups to develop their knowledge of health issues, and increase their self-reliance and competence to solve their own health problems through their own initiatives. A major determinant of good or ill health is the knowledge people have about health issues, their beliefs, attitudes and behaviour, and their desire to bring about positive behaviour change in their lives.

A key role for you as a health worker is to provide effective health education to the people in your community, so they can discuss their health problems with you and with each other, and make the right decisions to improve their health, and that of their family members, through their own efforts. Hence, health education is a vital tool for moving people to action. If health education is delivered in a well-planned and coordinated programme, with full community support and participation, there is no better way to encourage positive health behaviours and resolve or prevent many common health problems.

Positive health behaviour is any action of an individual that results in improvement in his or her health, or in the health of others in the community.

The second box in Figure 2.1 refers to health screening — the routine testing of individuals to see if they are at risk of developing a health problem. Health screening is an important health promotion activity that you will conduct as part of your antenatal care service. For example, you will take the temperature, blood pressure and pulse of every pregnant woman at every antenatal visit (we show you how to do this in Study Session 9) to see if she may be developing a health problem that could harm her or her baby.

The last box in Figure 2.1 refers to disease prevention, which means any action taken to prevent a disease from developing. For example, giving pregnant women iron supplements as a routine part of antenatal care is an action to prevent the development of anaemia — a condition in which the body makes too few red blood cells because the woman’s diet does not contain enough iron. (You will learn about the detection and treatment of anaemia in Study Sessions 9 and 18 of this Module.)

You can see from the above discussion that health promotion includes a wide-ranging set of activities. In later study sessions in this Module, you will learn a lot about the specific health education, health screening and disease prevention activities that contribute to the antenatal care of pregnant women in your community. In this study session, we will focus on the general principles of health education as a key aspect of health promotion in antenatal care.

2.2 Educating your community about antenatal care

Health education enables people to understand and analyse their health problems, and it motivates and leads them in the right direction to effect the desired change. In the context of antenatal care, it helps to educate, motivate and encourage pregnant women to use the service by providing information that helps them to make informed decisions. Moreover, it advocates greater acceptance and uptake of antenatal care by educating the whole community. The result is that everyone understands that the overall benefits of antenatal care are the promotion of maternal and newborn health, and the prevention of common diseases and complications during pregnancy, labour, delivery and the postnatal period. Effective antenatal care helps to detect complications early, and it leads to swift management, including referral to a higher health facility when necessary. It encourages people to make preparations for possible emergencies during pregnancy and childbirth, and it brings about a sustained reduction in maternal and newborn deaths and complications.

Your role is to ensure community awareness of the antenatal care services you provide for pregnant women, and to inform women, their families and community members about the danger signs, and where to seek emergency care. (You will learn about the danger signs in later study sessions.) You need to ensure that everyone in the community is aware of the need to plan in advance for emergency transportation, should the need arise.

You will certainly save lives, even though the overall health of those around you is not in your hands alone. This is because people decide for themselves how to use your advice, and what choices to make about their own health and that of other family members. By teaching and sharing information, you can help people to make their own choices more wisely. Your first task is to educate your community and promote positive health behaviour.

An antenatal care visit is a good opportunity to promote dialogue with your clients, and reinforce positive health messages. Therefore, you need to encourage women to come for the first antenatal visit early in pregnancy. In the next part of this study session, you will learn about the best methods for achieving this aim.

2.3 Methods of communicating health messages

2.3.1 Two-way communication

To promote improved utilisation of antenatal care services, good communication plays a key role. Communication methods are all the ways in which people exchange ideas, feelings and information, including through conversation, print media such as books and leaflets, posters, radio, television, and increasingly through the internet, where facilities allow. Effective health education involves a two-way dialogue.

Two-way communication is the best method to promote health education messages to individuals or groups. There should be a free flow of communication between all participants. Remember, your ears are two of your most important tools! This is particularly important in health education because it enables you to get useful feedback from everyone, and to understand their concerns and resolve them through discussion.

Figure 2.2 Community gatherings are good times to get positive health messages across; involve men as well as women in discussing the benefits of antenatal care.

2.3.2 Choose communication methods to suit your audience

Health promotion is not a one-time affair. It is a continuing process, based on planned and organised activities. It addresses different community members and uses different communication methods as appropriate; it is not limited to a specific audience and one method only. Health promotion involves active and full participation of the whole community, and is based on the reality of the area’s culture, traditions, language and local resources. People learn differently, and everyone learns better when they learn the same thing in different ways. After you talk with individuals or groups about the benefits of antenatal care, they will share their experience with others in the community, so they also become agents of positive change.

2.3.3 Advocacy and community mobilisation

Advocacy is speaking up for, or acting on behalf of, yourself or another person. Community mobilisation refers to a broad scale movement to engage people’s participation in achieving a specific goal through self-reliant efforts. Advocacy and community mobilisation will help you to gain and sustain the involvement of a broad range of influential individuals, groups and sectors at different levels in the community, who will support the antenatal care programme.

If you are successful in educating advocates to speak up for antenatal care, and in mobilising broad scale support for the service, the outcomes can include:

• Improving access to antenatal services for pregnant women, and its acceptance in the community
• Providing forums for discussion and coordination of the antenatal care service
• Mobilisation of community resources, such as transportation, outreach and emergency funding for pregnant and labouring women with complications that require urgent medical attention.

Engaging the support of advocates who are ‘opinion leaders’ or ‘key persons’ in your locality is an important task. Well-known and respected elders, traditional or religious leaders, and ‘wise persons’ whose advice and words are accepted in the community, can convince others of the benefits of the antenatal care service by exerting social pressure. The tendency of community members to agree with them is important in conveying your health messages and getting acceptance from others.

You can use these community-honoured leaders to communicate positive messages about antenatal care if you give them the right information, and you are ready to use them as advocates. Advocacy by respected leaders can make sure people maintain the positive behaviour changes you have brought about through health education.

Try to get the maximum number of people involved in the promotion of antenatal care, so that the community will really strengthen its support for pregnant women’s health (Figure 2.3).

Figure 2.3 Community mobilisation to support antenatal care involves the whole community, since a pregnant woman’s health can be protected or hurt by everyone.

As much as possible, encourage men to be partners in improving women’s health. Husbands, fathers, sons, community leaders, spiritual leaders, bosses and other men all play a role in how healthy women will be in relation to pregnancy, labour and delivery. If the men of the community feel responsible for the health of women, the whole community will benefit. So help men to be involved in the promotion of antenatal care.

Build on the roles and skills that men already have. For example, in many communities men are seen as protectors. Help men learn how to protect the health of women. Encourage men to share the responsibilities of pregnancy and parenting. Men can care for children in the same ways that women do — comforting, bathing, feeding, teaching, and playing with them. Invite women and men to community meetings, and encourage women to speak up. Sometimes women feel reluctant to speak about pregnancy and birth issues in front of men.

Work with men who are sympathetic to women’s needs. They can talk to other men who may listen more closely to a man than to a woman. When you discuss antenatal care with them, try to give practical suggestions. Men who care very much about the health of women in their lives may not know where to start. For example:

• Explain to a man that his pregnant wife needs help with her daily work (see Figure 2.4).

Figure 2.4 Women need extra help with their work during pregnancy.

• Encourage the couple to make a birth plan together, and to be aware of the danger signs during pregnancy, childbirth, and after birth. Advise them to save some money in case of an emergency, and make arrangements for transport if she has to go to a health centre or hospital.
• Make sure the man knows he must send for you when his wife goes into labour (if her pregnancy has been normal and she has no danger signs), so you can be there for the delivery.
• Make sure he knows where to take his wife for emergency care at a health facility if complications occur.
• Show him how a husband supports his wife during labour, for example how and where to rub her back to relieve her pain.
• Tell men how they can get tested and treated for sexually transmitted infections. If only a woman is treated, she will quickly be infected again by her partner.

2.3.4 Organising a health campaign

Health campaigns promote health knowledge, skills, attitudes and values on a particular health issue. They may also be used to accomplish a particular community improvement project. The actual community activities of a campaign often take place during only one week or one month. For this reason, campaigns are often called ‘Health Weeks’.

A health campaign to promote the uptake of antenatal care could be organised around one issue or problem that has been identified by community members themselves. For example, publicising the benefits of antenatal care services for pregnant women would be a priority campaign in a community where the antenatal care coverage rate was low. If there is a health committee in the community, it should be active in identifying issues for health campaigns, and planning the action to be taken.

Figure 2.5 The campaign logo of Ethiopia’s ‘Safe Motherhood Month’ in January 2010.

Health campaigns can also be conducted at a national level. For example, Ethiopia conducted a campaign called ‘Safe Motherhood Month’ in January 2010. The focus of the campaign was ‘No mother should die while giving birth’ (Figure 2.5).

The problem identified was high maternal deaths and complications related to pregnancy and childbirth. At the same time, there was low uptake of maternal health services, such as antenatal care, skilled birth attendance and family planning. Throughout the whole month, advocacy and social mobilisation campaigns were conducted using different communication media, including posters, television broadcasts and radio. There were panel discussions with stakeholders, religious leaders, parliamentarians, and so on, about the magnitude of the maternal health problem and sharing best practice on service provision. Campaigns on family planning and HIV counselling and testing also took place during the month.

2.3.5 Special community events

Every community has festivals, celebrations and ceremonies, e.g. to mark special seasons of the year, such as planting time, the harvest and the New Year; there are many religious festivals and days in remembrance of national occasions and heroes. Some events are a time for enjoyment and relaxation, such as the coffee ceremony. Others call for serious thinking and quiet devotion. People celebrate in different ways, according to the culture and norm of the community. Whatever the purpose of the ceremony or festival may be, the whole community usually participates. All these events can be useful occasions to disseminate information on antenatal care and conduct activities that promote maternal and newborn health.

2.3.6 Group discussions

Group discussion is the most commonly employed method of health education. It involves the free flow of communication between a facilitator and two or more participants (Figure 2.6).

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Figure 2.6 Group discussions create a forum for exchanging experiences.

The advantages of group discussion as a method of health promotion are that it:

• Encourages equal participation from all members
• Increases motivation to act on the health education message
• Helps participants to synthesise knowledge, new ideas and skills
• Creates a supportive forum for learning and exchanging experiences
• Promotes collective thinking to identify and solve problems by pooling ideas and expertise.

Group discussions are extremely useful as a method of health education if they have a shared goal, and collective planning and implementation of subsequent actions. Box 2.1 gives some steps for facilitating an effective discussion group.

2.3.7 Individual health education

Individual health education occurs when you exchange ideas and information with one other person. It is more forceful than any other communication method. It will help you to create mutual understanding with the other person and get to know each other more closely. It promotes frankness between participants and enables them to exchange ideas and give and receive feedback immediately. It also creates the opportunity to discuss problems which are sensitive and need special handling, as is often the case in pregnancy. In individual communication, it is essential to start by building a good relationship. Box 2.2 gives some steps to help you do this.

2.4 Planning a health education event

2.4.1 Preparation is essential

Figure 2.7 Books and study help you to prepare for a health education event.

If you are planning a health education event to promote the uptake of antenatal care, or any other health education topic, thorough preparation is essential. Begin by preparing well in advance everything you need to know about the topic, researching the main points and assembling all the necessary information (Figure 2.7).

Think carefully about the audience and pinpoint what they need. For example, if your audience is community leaders, you need to prepare your messages in relation to their knowledge and role. An event for elders will need different messages than an event for new parents, or single mothers, and so on. Consider the needs, feelings and wishes of the specific audience, and identify what points they are likely to want you to focus on.

Choose a place and time that is convenient for as many people as possible to be present. For example, if most people prefer to attend the event on Saturday at the kebele compound at 9:00am, try as much as possible to agree to their choice.

2.4.2 Getting started

When you conduct a health education event or meeting, ensure that everybody is seated comfortably and is ready for active participation in the discussion. Smile, and try to make eye contact with everybody as you welcome them and introduce yourself. Ask everyone present to introduce themselves.

Start the presentation with what people know already about the antenatal care service, and build on, or add, what people do not know. You may need to tell them about its advantages, how often and at what time a pregnant woman should have antenatal check-ups, and so on.

Choose your presentation method according to the audience’s condition, number, age, sex, etc. For example, a group of pregnant women may like it if you show them pictures of the uterus with a baby growing inside, or demonstrate how a baby moves down the birth canal, using a doll. Community leaders may benefit from seeing data on maternal and newborn mortality rates (as in Study Session 1 of this Module), to convince them of the need for antenatal care.

2.4.3 Keeping everyone involved

Concentrate on what can be done and achieved in the time available for the event. Don’t try to give out too much new information all at once, or people may feel overloaded and stop listening.

Remember, two-way communication is the best method! Participants should be encouraged to share their knowledge and experiences, and express their ideas and suggestions freely.

Support the active participation of women in particular, since they are the ones who should be encouraged to use antenatal care services. Some people are used to speaking up in groups, and others may be shy or afraid. Therefore, you should encourage those women who usually keep quiet to share their thoughts.

Make sure that everyone gets an equal chance to participate. For example, if a group of women wants to learn about what to eat during pregnancy and after birth, you can first ask each person to share what she knows. Many women will already know about a healthy diet from books or classes, from talking to other women, or from their own experience. But some women may be misinformed, for example about foods they think should be avoided in pregnancy, which are in fact good for pregnant women to eat, if they can afford to buy them (Figure 2.8).

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Figure 2.8 Health education events can reveal many different views, for example about a healthy diet during pregnancy.

2.4.4 Concluding the event positively

When the time approaches to bring the event to a conclusion, find out what questions, comments or issues anyone still has, and give particular attention to answering questions as much as possible before the meeting ends.

Then summarise the points that have been discussed, and any agreements reached, and bring the meeting to a close.

Thank everyone for their participation and encourage them to tell others what they have learned. They can become good advocates for antenatal care.

In the next study session, we turn our attention to the anatomy and physiology you will need to learn about in order to give good antenatal care.

Summary of Study Session 2

In Study Session 2, you have learned that:

1. The main purpose of promoting the utilisation of antenatal care is to reduce the number of maternal and newborn deaths and complications.
2. Antenatal care is an opportunity to promote dialogue with clients, to reinforce maternal health messages about danger signs during the antenatal, delivery and postnatal periods, and to ensure everyone knows where to seek appropriate care.
3. Health promotion covers any activities that result in better health in a community or a country; it can involve the actions of individuals, groups, organisations, institutions and governments. Health education, health screening and disease prevention all contribute to health promotion activities.
4. Health education enables people to increase control over, and improve, the health of themselves, their families and their communities by their own actions and efforts. It is a continuing process, based on planned and organised activities that take account of the audience’s culture, tradition, language and local resources.
5. Advocacy and community mobilisation help to gain and maintain the involvement of a broad range of individuals, groups and sectors at different levels in the community, in achieving the desired goal.
6. Educating influential opinion leaders, religious leaders, husbands and fathers to be advocates and partners in improving women’s health during pregnancy, labour and delivery, is very important.
7. Health promotion campaigns, education events, discussion groups and communication with individuals should be carefully prepared, and use different communication and presentation media as appropriate.
8. Group discussion is the most commonly used health education method. It involves two-way communication, in which participants are given an equal chance to express their views freely, and exchange their experiences and ideas.
9. Individual health education is based on creating trust and mutual understanding, enabling frankness between participants, the free exchange of ideas, and immediate feedback.
10. A good place to start is by listening to your audience. When you find out what people already know, you can help them build on that knowledge, and when you listen, you will learn from those you are educating.
11. Provide opportunities to make the antenatal care service the community’s own programme, by promoting the identification of problems and solutions, the planning and implementation of positive actions, and the evaluation of outcomes.

Self-Assessment Questions (SAQs) for Study Session 2

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.