Maternal and Child Health Journal

, Volume 23, Issue 1, pp 109–119 | Cite as

Best Practices for the Design, Implementation and Evaluation of Prenatal Health Programs

  • Rebecca A. Chedid
  • Karen P. PhillipsEmail author


Introduction Prenatal health programs provide health education, reproductive care and related services to women. Programs may be administered individually or collaboratively by agencies including public health units, hospitals, health clinics, community and non-governmental organizations. Prenatal health disparities among populations at-risk may be reduced through the provision of accessible health education, services and resources to help women mitigate modifiable risks to pregnancy. Although standardized guidelines inform clinical screening, testing and maternity care, gaps exist regarding the design, implementation and evaluation for comprehensive prenatal health programs. Methods Using a multijurisdictional approach, prenatal health guidance documents released by clinical associations and regional governments across Canada, Australia, the United States, the United Kingdom and Ireland were systematically evaluated to identify standards and practices regarding the design, implementation and evaluation of prenatal health programs. Results Evidence-based, surveillance/monitoring, and expert/stakeholder collaborations were principles affirmed by guidance documents across all jurisdictions. Each jurisdiction described tailored strategies to optimize prenatal health in their respective communities. Divergence between jurisdictions was noted for patient care models and promotion of providers and companions of choice. Discussion A best practices model is proposed describing recommendations as follows: prenatal health programs should be grounded in a theoretical approach, fundamentally woman-centered and designed to address interacting prenatal health determinants across the lifespan. Accessible and inclusive prenatal health care can be achieved through provider training and community stakeholder collaborations. Identification of best practices for prenatal health program design, implementation and evaluation ensures that service standards are harmonized across communities, thereby optimizing maternal and child health.


Pregnancy Health promotion Prenatal care Prenatal health Woman-centered care 



Funding was provided by Faculty of Health Sciences, University of Ottawa.


  1. Atrash, H. K., Johnson, K., Adams, M., Cordero, J. F., & Howse, J. (2006). Preconception care for improving perinatal outcomes: The time to act. Maternal and Child Health Journal, 10(5 Suppl), S3–S11.CrossRefGoogle Scholar
  2. Australian Government Department of Health. (2015). National antenatal care guidelines. Retrieved October 22, 2017, from.
  3. Bernloehr, A., Smith, P., & Vydelingum, V. (2005). Antenatal care in the European Union: A survey on guidelines in all 25 member states of the Community. European Journal of Obstetrics & Gynecology and Reproductive Biology, 122(1), 22–32.CrossRefGoogle Scholar
  4. Chalmers, B., Mangiaterra, V., & Porter, R. (2001). WHO principles of perinatal care: The essential antenatal, perinatal, and postpartum care course. Birth, 28(3), 202–207.CrossRefGoogle Scholar
  5. Fahy, K. (2012). What is woman-centred care and why does it matter? Women and Birth, 25(4), 149–151.CrossRefGoogle Scholar
  6. Feijen-De Jong, E. I., Jansen, D. E., Baarveld, F., Van Der Schans, C. P., Schellevis, F. G., & Reijneveld, S. A. (2012). Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: A systematic review. European Journal of Public Health, 22(6), 904–913.CrossRefGoogle Scholar
  7. Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual Review of Public Health, 31, 399–418.CrossRefGoogle Scholar
  8. Government of Nunavut, Department of Health and Social Service. (2009). Nunavut Maternal and Newborn Health Care Strategy 2009–2014. Iqaluit, Nunavut: Department of Health and Social Services, Government of Nunavut; ISBN 978-1-55325-169-9.Google Scholar
  9. Haertsch, M., Campbell, E., & Sanson-Fisher, R. (1999). Prenatal care guideline comparisons between Canada, US, Australia: What is recommended for healthy women during pregnancy? Birth, 26(1), 24–30.CrossRefGoogle Scholar
  10. Handler, A., & Johnson, K. (2016). A call to revisit the prenatal period as a focus for action within the reproductive and perinatal care continuum. Maternal and Child Health Journal, 20, 2217–2227.CrossRefGoogle Scholar
  11. Heaman, M. I., Moffatt, M., Elliott, L., Sword, W., Helewa, M. E., Morris, H., et al. (2015). Perceptions of barriers, facilitators, motivators related to use of prenatal care: A qualitative descriptive study of inner city women in Winnipeg. SAGE Open Medicine. Scholar
  12. Hoang, H., Le, Q., & Terry, D. (2014). Women’s access needs in maternal care in Tasmania Australia. Women and Birth, 27(1), 9–14.CrossRefGoogle Scholar
  13. Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., et al. (2006). Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recommendations and Reports, 55(6), 1–23.Google Scholar
  14. Keller, L. O., Strohschein, S., Lia-Hoagberg, B., & Schaffer, M. A. (2004). Population-based public health interventions: Practice-based and evidence-supported. Part I. Public Health Nursing, 21(5), 453–468.CrossRefGoogle Scholar
  15. Langer, B., Caneva, M. P., & Schlaeder, G. (1999). Routine prenatal care in Europe: The comparative experience of nine departments of gynaecology and obstetrics in eight different countries. European Journal of Obstetrics & Gynecology and Reproductive Biology, 85(2), 191–198.CrossRefGoogle Scholar
  16. Lu, M. C. (2010). We can do better: Improving perinatal health in America. Journal of Women’s Health, 19(3), 569–574.CrossRefGoogle Scholar
  17. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377.CrossRefGoogle Scholar
  18. Miller, K. J., Couchie, C., Ehman, W., Graves, L., Grzybowski, S., Medves, J., Joint Position Paper Working Group. (2012). Rural maternity care. Journal of Obstetrics and Gynaecology Canada, 34(10), 984–991.CrossRefGoogle Scholar
  19. Misra, D. P., Guyer, B., & Allston, A. (2003). Integrated perinatal health framework: A multiple determinants model with a life span approach. American Journal of Preventive Medicine, 25(1), 65–75.CrossRefGoogle Scholar
  20. Muhajarine, N., Ng, J., Bowen, A., Cushon, J., & Johnson, S. (2012). Understanding the impact of the Canada prenatal nutrition program: A quantitative evaluation. Canadian Journal of Public Health, 103(7 Suppl 1), eS26–eS31.Google Scholar
  21. Novick, G. (2009). Women’s experience of prenatal care: An integrative review. Journal of Midwifery & Women’s Health, 54(3), 226–237.CrossRefGoogle Scholar
  22. Price, S., Noseworthy, J., & Thornton, J. (2007). Women’s experience with social presence during childbirth. MCN, The American Journal of Maternal Child Nursing, 32(3), 184–191.CrossRefGoogle Scholar
  23. Public Health Agency of Canada. (2013). Implementing the population health approach. Retrieved October 22, 2017, from
  24. Shah, P. S., & Shah, J., Knowledge Synthesis Group on Determinants of Preterm/LBW Births. (2011). Maternal exposure to domestic violence and pregnancy and birth outcomes: A systematic review and meta-analyses. Journal of Women’s Health, 19(11), 2017–2031.CrossRefGoogle Scholar
  25. Smylie, J., Kirst, M., McShane, K., Firestone, M., Wolfe, S., & O’Campo, P. (2016). Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review. Social Science & Medicine, 150, 128–143.CrossRefGoogle Scholar
  26. Sutherland, G., Yelland, J., & Brown, S. (2012). Social inequalities in the organization of pregnancy care in a universally funded public health care system. Maternal and Child Health Journal, 16, 288–296.CrossRefGoogle Scholar
  27. Sword, W., Heaman, M., Brooks, S., Tough, S., Janssen, P., Young, D., et al. (2012). Women’s and care providers’ perspectives of quality prenatal care: A qualitative descriptive study. BMC Pregnancy and Childbirth, 12, 29.CrossRefGoogle Scholar
  28. Tarasoff, L. A. (2015). Experiences of women with physical disabilities during the perinatal period: A review of the literature and recommendations to improve care. Health Care for Women International, 36(1), 88–107.CrossRefGoogle Scholar
  29. United Nations. (1996). Report of the fourth world conference on women, Beijing, 415 September 1995. New York: United Nations, ISBN 92-1-130181-5.Google Scholar
  30. Vonderheid, S. C., Norr, K. F., & Handler, A. S. (2007). Prenatal health promotion content and health behaviors. Western Journal of Nursing Research, 29(3), 258–276.CrossRefGoogle Scholar
  31. World Health Organization. (1986). Health promotion, the Ottawa Charter for Health Promotion. Retrieved October 22, 2017, from
  32. World Health Organization. (2015) WHO recommendations on health promotion interventions for maternal and newborn health. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Interdisciplinary School of Health Sciences, Faculty of Health SciencesUniversity of OttawaOttawaCanada

Personalised recommendations