Toolkit for adaptation of the WHO recommendations for a positive pregnancy and postnatal experience

What this guideline says

GMJ summary

This toolkit provides a structured, four-step process for countries to adapt the 2016 WHO antenatal care (ANC) recommendations and the 2022 postnatal care (PNC) recommendations to their national context. It guides ministries of health and national programme managers through conducting a baseline assessment of current service provision, organizing stakeholder meetings, creating or updating national guidelines, and holding validation meetings to achieve consensus and plan implementation.

The toolkit centres on a baseline assessment tool (BAT) comprising 12 worksheets that enable country teams to evaluate current ANC and PNC provision against WHO recommendations and produce two key outputs: a country-specific package of ANC and/or PNC interventions, and a SWOT (strengths, weaknesses, opportunities, threats) analysis to inform implementation planning. The WHO ANC model proposes eight scheduled contacts during pregnancy; the PNC model proposes four contacts after birth—one within 24 hours (in facility for at least 24 hours or home visit), at 48–72 hours, 7–14 days, and at six weeks postpartum.

The toolkit emphasizes the importance of multistakeholder engagement, including representatives from vertical programmes (malaria, TB, HIV, immunization), health information systems, supply chain, professional associations, implementing partners, and community groups. It has been pilot-tested in Burkina Faso, India, Rwanda, Zambia, and Guinea, with revisions informed by country feedback to support both ANC and PNC adaptation together or separately.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. The WHO ANC model schedules eight contacts: up to 12 weeks, at 20, 26, 30, 34, 36, 38, and 40 weeks of gestation, with return for delivery at 41 weeks if not given birth.
2. The WHO PNC model schedules four contacts: within first 24 hours after birth (facility care for at least 24 hours or home visit within 24 hours), at 48–72 hours, between 7–14 days, and during week 6 postpartum.
3. All pregnant women should receive daily iron and folic acid supplementation for 90+ days during pregnancy (ANC Recommendation A.2.1).
4. One ultrasound scan before 24 weeks of gestation is recommended to estimate gestational age, detect fetal anomalies and multiple pregnancies, and reduce induction for post-term pregnancy (ANC Recommendation B.2.4, updated 2022).
5. In malaria-endemic areas, intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine should be provided at each ANC contact from 13 weeks onwards (ANC Recommendation C.6, context-specific).
6. Universal newborn screening for hyperbilirubinaemia using transcutaneous bilirubinometer should be part of discharge readiness assessment (PNC Recommendation B.1.4).
7. Exclusive breastfeeding should be supported from birth until 6 months of age at every postnatal contact (PNC Recommendation B.5.1).
8. Women should receive postnatal care in the facility for at least 24 hours after birth; for home births, first contact should occur within 24 hours (PNC Recommendation C.1).

WHO ANC model for a positive pregnancy experience: recommendations mapped to eight scheduled ANC contacts

Table extracted from the guideline

Source: World Health Organization, Toolkit for adaptation of the WHO recommendations for a positive pregnancy and postnatal experience. Reproduced in summary form.

What changed in this edition

Versus the previous edition

• The toolkit has been revised from the original 2018 ANC-only version to include the 2022 PNC recommendations and support adaptation of both ANC and PNC together or separately.
• Updates to ANC recommendations incorporated include: one ultrasound scan before 24 weeks (2022 update), multiple micronutrient supplements (2020 update), vitamin D supplements (2020 update), and zinc supplements (2021 update).
• The baseline assessment tool now includes 12 worksheets covering both ANC (Worksheets 1–4) and PNC (Worksheets 5–8), with shared worksheets for situational analysis summary, policy document mapping, and monitoring indicators.
• Qualitative evidence synthesis (QES) slides have been updated to include findings from both ANC and PNC qualitative reviews documenting values and preferences of women, partners, families, and health workers.
• The revised toolkit was tested in Guinea and Rwanda in 2023 following initial pilot testing in Burkina Faso, India, Rwanda, and Zambia between 2018–2019.

From the guideline

Verbatim

“All babies should be exclusively breastfed from birth until 6 months of age. Mothers should be counselled and provided support for exclusive breastfeeding at each postnatal contact.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

Related on GMJ

Interconnected resources

GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.