Prenatal classes in Georgia turn pregnancy into a life-course opportunity for health

Ministry of Labour/David Kharatishvili

Tinatin Gagua, gynaecologist and head of the antenatal care clinic in Tbilisi, Georgia, provides health information to pregnant women and their partners during prenatal classes.

Pregnancy is a delicate time in a woman’s life. By ensuring high-quality and people-centred health services for mothers-to-be, health systems make a valuable investment, with benefits that go well beyond pregnancy.

“When we started our training in 2011, antenatal care was a brand new concept in Georgia. Doctors were not used to spending time informing pregnant women about their pregnancies and their babies’ health,” comments Tinatin Gagua, head of an antenatal care clinic in Tbilisi, Georgia. “We were trained to give classes to groups of pregnant women. Being in a group made a great difference because it helped women to ask questions and socialize with their peers.”

“Pregnancy is not a disease,” says Gunta Lazdane, Programme Manager for Sexual and Reproductive Health at the WHO Regional Office for Europe. “It offers an opportunity for health-care providers to work across sectors to address many aspects of health, leading to a reduction in disease and death and improvements to well-being. The information given to pregnant women is passed from mothers to their children and wider families, from generation to generation, and is a prime example of the life-course approach, as health behaviour at this critical time in life influences health behaviour and affects health later in life.”

WHO’s recommendations on antenatal care

It is possible to end preventable maternal deaths, but this is not happening in some countries because access to services is still lacking and the quality of care is inadequate. WHO’s guidelines on antenatal care are an effective tool to tackle these problems and improve maternal health using a primary care approach. This means that an antenatal visit is more than a check of pregnancy progress, and that every visit matters. It ensures continuity of care and turns visits into opportunities to learn about healthy lifestyles, early diagnosis of chronic diseases and other preventive measures.

“WHO is committed to supporting adoption of the antenatal care guidelines in regions and countries, particularly by undertaking policy dialogue at the national level, and to helping update national guidelines and protocols with a specific focus on quality of care over the coming years,” explains Maurice Bucagu at the WHO headquarters Department of Maternal, Newborn, Child and Adolescent Health.

The antenatal care recommendations aim to provide a positive experience for all pregnant women and to reduce pregnancy complications and cases of stillbirth by:

  • increasing the recommended number of visits to health care providers throughout pregnancy from 4 to 8, providing more opportunities to detect and manage potential problems and to reduce perinatal deaths; and
  • recommending what to offer pregnant women during visits, such as counselling on diet and optimal nutrition, physical activity, tobacco and substance use and HIV prevention; blood tests and vaccinations; fetal measurements; advice about dealing with common physiological symptoms; and information about other issues such as intimate partner violence.

Antenatal care in Georgia

Georgia is playing a pilot role for eastern Europe and central Asia in implementing the updated WHO antenatal care recommendations, which take account of additional evidence from the last 15 years. In line with a human-rights and a life-course approach, the new guidelines not only address the prevention of death and disease but also prioritize person-centred health care and well-being.

The biennial collaborative agreement between WHO and the Government of Georgia for 2016–2017 focuses on promoting health through the life-course, preventing and controlling noncommunicable diseases, advancing universal health coverage and improving primary health care, among other areas. Within this framework, WHO has supported the Georgian Ministry of Health to roll out the guidelines in the country, including through policy dialogues.

Improving information during pregnancy breaks down myths and lowers anxiety

More frequent contact throughout pregnancy facilitates education of mothers-to-be and their families – for example, allowing doctors to bring women to visit hospitals, meeting midwives and seeing the delivery rooms. It also allows evidence-based messages to be shared. “In most countries, the source of information about many issues related to pregnancy is not the doctor. We provide women with information that often breaks down myths regarding physical activity and sexual relations that were handed down by their mother or mother-in-law. The classes make pregnancy easier and lower fear and anxiety – after them, women are more relaxed. Women from all socioeconomic groups benefit from this interaction and are really eager to learn,” explains Tinatin.

Antenatal classes for women and their partners

WHO assists health professionals in improving antenatal care among all population groups – including adolescent girls, elderly mothers and those in rural, poor or hard-to-reach areas or conflict settings – by organizing training. “The establishment of classes for pregnant women and future parents changed prenatal services in Georgia. We found we needed fewer epidurals and C-sections on demand, and the number of complications decreased”, states Tinatin. “I strongly believe that an informed patient is a better patient. The training not only helps us as doctors to ensure safer pregnancies and better deliveries, it also creates trust in us and in the facilities.” She adds that as a co-benefit, the approach of men has also changed. “While it is not common in our society to involve men in pregnancy health care, classes are a way to engage them – a big step forward. We now have deliveries where the father is present at the birth, which was not at all the case previously. With C-sections and epidurals, we now use skin-to-skin contact with the father.”

Classes also facilitate discussions on health-related issues, such as nutrition: a healthy diet is very important in pregnancy and the one-to-one consultations are not always enough to discuss every detail. Nutrition during pregnancy affects the health both of the woman and of the family and future generations. WHO has helped to revise and develop new guidelines on nutrition during pregnancy and breastfeeding.

Antenatal care promotes the Sustainable Development Goals (SDGs)

The focus on women and infants following a life-course approach to health is in line with the cross-cutting vision of the 2030 Agenda for Sustainable Development, in which governments from across the globe agreed that “to promote physical and mental health and well-being, and to extend life expectancy for all, we must achieve universal health coverage and access to quality health care. No one must be left behind.” Providing improved antenatal care to all pregnant women is consistent with the Alma Ata Declaration and the European health policy framework, Health 2020. It also contributes to achieving SDG3, which seeks to ensure health and well-being for all at every stage of life and addresses a range of health priorities. Health sector interventions such as prenatal classes contribute to achieving SDG3 by improving lifestyles, with potential effects on preventing communicable and noncommunicable diseases. Further, they aid work towards other Goals, including SDG2 by improving nutrition and SDG5 by increasing women’s empowerment.