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Women participating in group prenatal visits are more inclined to persist with their care, demonstrating improved health outcomes during childbirth and thereafter, as revealed by a University of Michigan investigation.

This study evaluated the prenatal care experiences of women in Malawi through a randomized trial where half of the participants received prenatal care in groups, while the other half underwent conventional one-on-one care. Results indicated that women in group prenatal care experienced better outcomes than those receiving individual care, with many expressing a preference for group care in future pregnancies.

“Numerous expectant mothers, especially in under-resourced areas, encounter significant challenges. Often, mental health is disregarded, and accessible health information is scarce. However, facilitating group prenatal care helps women develop valuable connections with peers and their midwife,” stated lead study author Crystal Patil, U-M nursing professor. “They don’t merely arrive to receive care and attend a lecture on healthy pregnancies—rather, they engage in collective problem-solving.”

The findings from this research, published in the journal PLOS One, present a framework and practical insights for U.S. healthcare providers and systems aiming to offer more effective, just, and sustainable perinatal care.

The research, backed by the National Institute of Nursing Research, randomly assigned 1,887 women into groups receiving either conventional individualized care or group care with approximately eight to twelve women at seven clinics in Malawi. Each group was guided by a midwife along with an experienced woman from the community, who acted as a volunteer.

Participants in group prenatal care reported a stronger sense of connection with peers, heightened pregnancy-related empowerment, a recollection of receiving more services, and an increased discussion of health topics. They also experienced shorter wait times and expressed greater satisfaction with their care.

The advantages extended beyond pregnancy. Women in group care felt more ready for childbirth, communicated better with their partners, and were more likely to consistently use condoms, which reflects a stronger commitment to HIV prevention and safer sexual practices. They also reported reduced mental distress during the late stages of pregnancy.

“Midwifery-led models that promote respect and the sharing of experiences and ideas facilitate women’s access to care, ensuring they remain engaged,” Patil remarked. “Attending more appointments allows midwives to tackle health concerns, such as high blood pressure. While most women understand what contributes to a healthy pregnancy, group visits empower them to convert that knowledge into action—by exchanging strategies, building confidence, and discovering practical ways to eat healthily and prepare for childbirth.”

Group prenatal care, initiated by U.S. midwife Sharon Rising, seeks to address quality-of-care challenges associated with traditional one-on-one care, including lengthy wait times and limited interaction with healthcare providers. This group approach allows for greater flexibility, enabling comprehensive health education discussions.

Women involved in group prenatal care start with an initial one-on-one visit, followed by additional sessions with the same group of expectant mothers at similar stages of pregnancy. They complete an initial health evaluation with a midwife in the group and then conduct self-assessments—such as measuring their blood pressure and weight—during subsequent meetings. After that, the group converses about health-promoting practices.

Patil believes the key lies in the “self-reinforcing cycle of enhanced care.” The concept is that when individuals feel more empowered during their pregnancies and build connections with peers, the services and health education discussed during their visits become exponentially more meaningful; thus, promoting improved perinatal health outcomes.

“We found that women enjoyed more varied diets and were better equipped for childbirth. They know what to do and what items to bring when visiting the health center, enhancing their awareness and capacity to act on issues that may concern them, such as bleeding and HIV prevention,” noted Patil.

The team devised and evaluated a three-step implementation strategy that fostered sustainability, allowing clinics to continue offering group care post-study. Patil mentions that, besides the initial seven clinics involved in the trial, group prenatal care has expanded to six new clinics in the Blantyre District. With backing from the Ministry of Health, group prenatal care has also reached at least three other districts in the nation.

Other African nations, including Ghana, Kenya, Nigeria, Rwanda, Tanzania, and Zanzibar, are initiating group health care models.

“A shift in the power dynamics accompanies group care. In contrast to individual visits, group care feels more relaxed and nurtures a sense of belonging through shared experiences,” Patil argued. “Having access to the right information and the ability to translate that into actionable solutions—that’s the essence of coming together as a group of women.”

The research team also featured Malawi investigators Ellen Chirwa, Esnath Kapito, Genesis Chorwe, Ursula Kafulafula, and Elizabeth Chodzaza. Patil’s fellow researchers included Kathleen Norr, Kylea Liese, and Rohan Jeremiah from the University of Illinois, Chicago.

This study received support from the National Institute of Nursing Research (R01NR018115).

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