Group Care during the first 1,000 days makes a difference around the world

Thema:: First 1000 days; Youth health

9 July 2024

Centering-based Group care during the first 1,000 days leads to better health outcomes, increased satisfaction among pregnant women and caregivers, and can reduce healthcare costs. Despite this, the Group Care model is not yet widely implemented.

In order to bridge this implementation gap, TNO and 9 other partners successfully introduced group care for pregnant women, their partners and for parents in the first 2 years after birth in Suriname, Ghana, South Africa, United Kingdom, Belgium, the Netherlands and Kosovo. Over 200 healthcare professionals were trained and 169 groups were implemented in 32 sites. All countries aim to continue with group care, even after the project ends.

The experiences in these seven countries, each with a different context and healthcare system, resulted in an implementation package of supporting materials for other countries to enable group care in their health care systems. These materials are freely available through the website www.groupcare1000.com

Group care in the Netherlands: indicator of good quality of care

In the Netherlands, group care during the first 1,000 days was introduced in 2012. Previous research by TNO and the University Medical center Leiden(LUMC) has shown that it leads to improved health outcomes and greater care satisfaction among pregnant women and healthcare providers. The Promising Start programme of the Ministry of Health has therefor adopted the availability of group care as an indicator of good quality of care.

The current EU project explored the implementation in five midwifery practices with a large population of pregnant women in vulnerable circumstances and in the well-baby clinics of three asylum seeking centers. In these contexts, group care was shown to be better suited to the needs and expectations of women and families, and as such contributes to reducing health inequalities. In addition, it also increased the work satisfaction among care providers.

'What we see is that during Group Care, the women developed a, how do you say, a motherhood or a sisterhood. That people are not alone anymore, but they are together. They support each other.'

Group Care facilitator (Midwife) from the Netherlands

Group Care: the proven solution

Group care is a model of care in which the medical check-ups of pregnant women and young children are offered in combination with group discussions about topics that are important during pregnancy and the first 1,000 days of their child. These discussions take place in stable groups, creating trust and mutual support between participants over time. Pregnant women and their partners and parents of young children are actively involved in the care.

'Everything was discussed very openly. Nothing was really too crazy, so basically I was able to just say everything I wanted to say, and there weren't really any topics that made me think hey, I don't dare to ask this, or I think I'm ashamed of this.'

Pregnant woman participating in Group Care

Group care improves key outcomes

International research has shown that Group Care has demonstrated significant benefits. Randomised studies involving over 14,000 women overall showed a trend towards a decrease in preterm births for those receiving Group Care compared to traditional care. Some studies also found a reduced disparity in preterm birth for Black women, relative to White and Hispanic women.

Moreover, the effects on preterm birth seemed to be stronger for low income Black women in the United States, which suggests that marginalized or under-served populations can benefit from Group Care.

There is some evidence suggesting a reduced occurrence of low birthweight in babies born to women who experienced antenatal Group Care. Group Care participants tend to have a reduced likelihood of caesarean section births and a lower likelihood of newborns being admitted to the neonatal intensive care unit (NICU). Beyond clinical outcomes, pregnant women and healthcare providers report higher satisfaction with Group Care than with traditional care, also in the Netherlands.

Dutch research also shows that among women in group care have a significantly lower risk of developing complications as a result of high blood pressure, that more women start breastfeeding and that they show improved health behaviours such as less alcohol consumption after childbirth, healthier eating habits and more exercise. There was also a trend towards reduced smoking during and after pregnancy. In addition, participants also appear to have more knowledge about pregnancy and birth.

'Without the group I think I would be more aggressive, more unsure of what to do. […] Yes, don’t be afraid to talk about things. Don’t be afraid to talk about what I am feeling inside. Release everything. […] Taking care of yourself, pause and do what you want, it really freed me, it really made me free.'

Participating Mother in Asylum Seeking Center

Time to step up!

Time to step up collective efforts to increase implementation and support scale-up of Group Care for the benefit of women and families worldwide!

TNO recognises and supports that changing the way healthcare is provided requires vision of what might be possible as well as guidance through the implementation process. Such change is both exciting and challenging.