13.1 Focused antenatal care: concepts and principles
Historically, the traditional antenatal care service model was developed in the early 1900s. This model assumes that frequent visits and classifying pregnant women into low and high risk by predicting the complications ahead of time, is the best way to care for the mother and the fetus. The traditional approach was replaced by focused antenatal care (FANC) — a goal-oriented antenatal care approach, which was recommended by researchers in 2001 and adopted by the World Health Organization (WHO) in 2002. FANC is the accepted policy in Ethiopia.
FANC aims to promote the health of mothers and their babies through targeted assessments of pregnant women to facilitate:
- Identification and treatment of already established disease
- Early detection of complications and other potential problems that can affect the outcomes of pregnancy
- Prophylaxis and treatment for anaemia, malaria, and sexually transmitted infections (STIs) including HIV, urinary tract infections and tetanus. Prophylaxis refers to an intervention aimed at preventing a disease or disorder from occurring.
FANC also aims to give holistic individualised care to each woman to help maintain the normal progress of her pregnancy through timely guidance and advice on:
- Birth preparedness (described later in this study session),
- Nutrition, immunization, personal hygiene and family planning (Study Session 14)
- Counselling on danger symptoms that indicate the pregnant woman should get immediate help from a health professional (Study Session 15).
In FANC, health service providers give much emphasis to individualised assessment and the actions needed to make decisions about antenatal care by the provider and the pregnant woman together. As a result, rather than making the traditional frequent antenatal care visits as a routine activity for all, and categorising women based on routine risk indicators, the FANC service providers are guided by each woman’s individual situation.
This approach also makes pregnancy care a family responsibility. The health service provider discusses with the woman and her husband the possible complications that she may encounter; they plan together in preparation for the birth, and they discuss postnatal care and future childbirth issues. Pregnant women receive fundamental care at home and in the health institution; complications are detected early by the family and health service provider; and interventions are begun in good time, with better outcomes for the women and their babies.
Box 13.1 summarises the basic principles of FANC.
Box 13.1 Basic principles of focused antenatal care
- Antenatal care service providers make a thorough evaluation of the pregnant woman to identify and treat existing obstetric and medical problems.
- They administer prophylaxis as indicated, e.g. preventive measures for malaria, anaemia, nutritional deficiencies, sexually transmitted infections, including prevention of mother to child transmission of HIV (PMTCT, see Study Session 16), and tetanus.
- With the mother, they decide on where to have the follow-up antenatal visits, how frequent the visits should be, where to give birth and whom to be involved in the pregnancy and postpartum care.
- Provided that quality of care is given much emphasis during each visit, and couples are aware of the possible pregnancy risks, the majority of pregnancies progress without complication.
- However, no pregnancy is labelled as ‘risk-free’ till proved otherwise, because most pregnancy-related fatal and non-fatal complications are unpredictable and late pregnancy phenomena.
- Pregnant women and their husbands are seen as ‘risk identifiers’ after receiving counselling on danger symptoms, and they are also ‘collaborators’ with the health service by accepting and practising your recommendations.