Antenatal care is any healthcare you receive in pregnancy before the birth of your child. Antenatal and prenatal mean the same thing, and you may see and hear them used interchangeably, though antenatal is more common in British English and prenatal is more common in the US. “Focused antenatal care (FANC)” is a term used for a structured approach to individualised care for pregnant women. The model was introduced by the World Health Organisation in 2002 and updated in 2016. One of its key goals is to encourage antenatal appointments that are fewer in number but more tailored to each individual mother's needs, which is distinct from the more traditional provision of lots of appointments that were less tailored. This makes it a great option for low- and middle-income countries, where women are less likely to utilise antenatal care resources effectively and, in cases where they need to pay for appointments, will not be able to afford many. WHO’s FANC recommendations are designed to be adaptable and flexible so that countries with different settings, diseases, social and economic situations, and health-system structures can adopt and implement them based on their country’s context and populations’ needs.

The FANC’s other key goals (as well as its chief benefits) are the same as those of any antenatal care: the prevention of maternal and infant death and the promotion of safety and wellbeing for mums and babies. These require lots of work to achieve because of the adjustments that must be made for specific risks and potential complications. The adjustments can range from extra monitoring to vaccinations, courses of medication, and special diet and lifestyle changes. The importance of focused antenatal care stems from the plain fact that every woman and each pregnancy is distinct. You can’t adjust for that in a way that is universally or even regionally applicable. You can save more lives and produce healthier families with focused antenatal care, which is why it is such a wise model to adopt (though many countries had their own versions of it already), while remaining imperfect and in need of constant evaluation and evidence-based updates to stay viable.

How did the focused antenatal care program come about, and why didn’t it exist before 2002?

International pregnancy care researchers recommended the program in 2001, and it was formalised a year later. Antenatal care has existed in some form since the early 1900s, and the features of FANC existed to varying degrees across the world before 2002. The point of the program is to offer clear and comprehensive guidelines for global use, regardless of a country's resources and state of development. The World Health Organisation is not a government or supranational organisation that can impose regulations; it can’t force any countries to follow the program. However, it was (and continues to be) based on such positive evidence that public officials and other healthcare professionals around the world can legitimately base their policy efforts upon it.

What are the key recommendations of the Focused Antenatal Care model (including the 2016 revision)?

Appointments at eight critical times in pregnancy (many women will have more than this; this is a baseline recommendation; the real focus of this model is that the appointments be tailored to the individual).
Health in pregnancy counselling, including provision of nutritional, supplement, and exercise advice
Smoking and alcohol cessation and caffeine restriction advice. Clinical enquiries about alcohol and tobacco use, including potential exposure to secondhand smoke.
Clinical enquiries about a woman’s risk of domestic violence
HIV testing and counselling
TB testing
dTAP vaccination
Investigation of Rhesus D status and anti-D injections after birth as necessary
Antibiotics for women with ASB to prevent preterm birth, low birth weight, and the persistence of the condition
Earlier ultrasound scans to determine gestational age, check for multiple pregnancies, and screen for foetal abnormalities. There is also evidence that this scan (known as the dating scan in the UK, but any scan before 24 weeks gestation is the FANC recommendation, so we could include the 20-week anatomy scan in this as well) makes post-term induction of labour less likely and improves a woman’s pregnancy experience overall.
More appointments in the third trimester than in the second or first trimester. This recommendation reflects how pregnancy complications are most likely to develop in this trimester.
Systematic wellbeing monitoring for mums and babies during pregnancy
Midwife-led continuity of care. This is not available everywhere, and it is expensive and not always possible to have the same midwife care for a woman throughout pregnancy and birth. However, there is plenty of evidence that this is beneficial for pregnancy outcomes.
Task shifting between qualified healthcare professionals throughout caregiving
Pregnancy notes to be carried by the woman throughout gestation
Clinical enquiries about a woman’s perception of foetal movements
Safe intervention recommendations for common pregnancy symptoms, such as nausea, heartburn, and constipation
Community mobilisation of groups such as women’s groups for childbirth and antenatal education

It is interesting and troubling to note that there aren’t any mental health recommendations, though this could reflect how the widespread availability of mental health screening, education, and treatment for pregnant women still isn’t possible in many countries. However, the World Health Organisation does recognise the importance of mental health in comprehensive pregnancy healthcare.

For more advice on taking care of yourself in pregnancy, labour, and birth, check out Unii’s Ultimate Antenatal Classes, with prenatal video episodes taught by senior NHS midwives, an award-winning obstetrician and gynaecologist, and six other leading healthcare experts. Now available at unii.com.

What is Focused Antenatal Care (FANC)? Benefits and Importance