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Implementation of the new WHO antenatal care model for a positive pregnancy experience: a monitoring framework
  1. Samantha R Lattof1,
  2. Allisyn C Moran1,
  3. Nancy Kidula2,
  4. Ann-Beth Moller3,
  5. Chandani Anoma Jayathilaka4,
  6. Theresa Diaz1,
  7. Özge Tunçalp3
  1. 1Department of Maternal, Newborn, Child, Adolescent Health and Ageing, WHO, Geneva, Switzerland
  2. 2Intercountry Support Team for East and Southern Africa, WHO Regional Office for Africa, Harare, Zimbabwe
  3. 3UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
  4. 4Department of Family Health, Gender and Life Course, WHO Regional Office for South-East Asia, New Delhi, Delhi, India
  1. Correspondence to Dr Allisyn C Moran; morana{at}


Monitoring the implementation and impact of routine antenatal care (ANC), as described in the new World Health Organization (WHO) ANC model, requires indicators that go beyond the previously used global benchmark indicator of four or more ANC visits. To enable consistent monitoring of ANC content and care processes and to provide guidance to countries and health facilities, WHO developed an ANC monitoring framework. This framework builds on a conceptual framework for quality ANC and a scoping review of ANC indicators that mapped existing indicators related to recommendations in the new WHO ANC model. Based on the scoping review and following an iterative and consultative process, we developed a monitoring framework consisting of core indicators recommended for monitoring ANC recommendations in all settings, as well as a menu of additional measures. Finally, a research agenda highlights areas where ANC recommendations exist, but measures require further development. Nine core indicators can already be monitored globally and/or nationally, depending on the preferred data sources. Two core indicators (experience of care, ultrasound scan before 24 weeks) are included as placeholders requiring priority by the research agenda. Six context-specific indicators are appropriate for national and subnational monitoring in various settings based on specific guidance. Thirty-five additional indicators may be relevant and desirable for monitoring, depending on programme priorities. Monitoring implementation of the new WHO ANC model and the outcomes of routine ANC require greater attention to the measurement of ANC content and care processes as well as women’s experience of ANC.

  • maternal health
  • obstetrics
  • public health

Data availability statement

The data extraction workbook for the scoping review is available on request from ÖT ( at the WHO.

This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (CC BY NC 3.0 IGO), which permits use, distribution,and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.Disclaimer: The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

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Data availability statement

The data extraction workbook for the scoping review is available on request from ÖT ( at the WHO.

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  • Handling editor Seye Abimbola

  • Contributors SRL wrote the first draft of the manuscript, and all authors contributed to subsequent revisions. SRL and ACM contributed equally to this paper.

  • Funding This work was supported by the United Nations Development Programme-United Nations Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, a cosponsored programme executed by the WHO.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.