This project consists of a randomized controlled clinical trial comparing two models of antenatal care. As background, a few years ago, the Institute sponsored with other agencies of the Public Health Service an Expert Panel on Prenatal Care which indicated that the current system of care, either in the schedule of visits as well as its contents is for the most part not based upon a careful scientific assessment. The recommendation of the Panel was to revise the schedule of prenatal care for low risk women in order to save resources which can be used for high risk women. It was also recommended that studies or trials be developed to evaluate different models of prenatal care. Prenatal care is viewed as a major determinant of infant mortality and morbidity and its careful evaluation obviously is of major research interest to the Institute. The WHO through a technical advisory panel has developed over the last two years a new model for prenatal care for developing countries which reduces the number of visits and also alters the content of prenatal care substantially. In the revised model, the content of prenatal care will consist predominately of the recognition and diagnosis of conditions and complications of pregnancy which are known to affect the health of women or birth outcome and specific interventions to deal with these conditions once identified. The DESPR, through its Director, has been an integral part of the design of this new model of prenatal care and has served as the Chair of the Technical Advisory Panel of the WHO. It is proposed that this trial be evaluated in four or five sites by randomizing clinics in these four or five sites. Clinics would be randomized to the current system of prenatal care or the new proposed model of prenatal care. There would be at least 12 clinics per participating center for a total of 24 clinics receiving the new model of prenatal care and 24 with the current system.
