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Abstract

Background
Maternal health care services across the globe often fall short of meeting the holistic needs of women and other birthing people. Growing literature connects disrespectful care, obstetric violence, obstetric racism, birth trauma and other negative experiences of care to gendered, racialised and class-coded power dynamics. Public health initiatives and organisations have pointed to more well-rounded, community-based and relational models of care to meet the multi-dimensional aspects of service users’ needs. Group antenatal care has established itself as a model embedded with an ethos and philosophy that may challenge service user-provider power dimensions. It is a group-based, facilitative and often midwifery-led model of antenatal care delivery which brings together a cohort of 8-12 women of similar gestation with health care facilitators for 2-hour sessions. Group care participants learn basic screening skills to interpret health measures and detect common pregnancy conditions alongside brief private 1:1 health check with the midwife during group sessions. The juxtaposition of standard 1:1 and group care provides insight into maternity care as a microcosm of society, positioning group care as a model with radical ethos and intended design which may more holistically speak to the needs of women, particularly those who are marginalised and underserved. Group Care for the First 1000 Days (GC_1000) is an international project invested in the implementation and upscaling of group antenatal and postnatal care across different health care systems in countries including Belgium, Ghana, Kosovo, South Africa, Suriname, the Netherlands and the United Kingdom (specifically England). Nested within the wider GC_1000 is the titled project, CentringLiberation a
Black feminist ethnography which aims to explore women’s experiences of group antenatal care through an intersectional lens of investigation.

Methods
As a part of the GC_1000 project, CentringLiberation draws upon multi-level data and diverse analytical approaches to explore women’s experiences of group antenatal care. This doctoral thesis is comprised of 5 manuscripts submitted to peer-reviewed journals for publication. Each article is an independent piece of research which together provide a multidimensional exploration of how the model works and for whom. By utilising thematic and narrative analyses, meta-synthesis as well as systemic review and creative approaches, CentringLiberation explores women’s experiences of pregnancy, birth and motherhood in the context of group antenatal care.

Findings
Data analyses from meta- to micro- experiences of group antenatal care underpinned by a Black feminist methodology, provided new insights to research on group care as well as Black feminism and medical anthropology. This research project: 1). identified how the model shapes women’s experiences of care and the ways in which women contribute to and learn from group care pedagogy; 2). llustrated the ways in which women actively contribute to space-making, community building and mobilisation in the group care context, 3). established how relational continuity is a significant and contributing pillar of group care’s mechanisms of delivery through a case study analysis, illustrating how its absence impact women’s experience of the model; 4). made visible pathways of the double-entendre of un/belonging for women in group care, particularly for those furthest from the axis of power and finally, 5). humanised ethnic minority women’s experiences of maternity care, making strange the process of racialisation in Britian’s maternity care system through creative research methods.

Conclusions
These research findings contribute to evidence supporting group care as an innovative model of care which has potential to cater to the multidimensional needs of women and their families. However, the implementation and delivery of fundamental components may vary, leading to inequitable experiences for women. Efforts to situate group care as a strengths-based maternity care model may further the groundwork to achieve equity in maternal health outcomes and experiences. Further research is needed to understand how to generate healing pathways within the group space.

Publication Type:	Thesis (Doctoral)
Subjects:	H Social Sciences > HM Sociology R Medicine > RA Public aspects of medicine R Medicine > RG Gynecology and obstetrics
Departments:	School of Health & Medical Sciences > Department of Nursing & Midwifery School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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