@article{fdi:010095516,
  title = {{A}ntenatal care interventions in {A}fghanistan from 2000 to 2024 : a rapid realist review},
  author = {{N}aseri, {S}. and {D}urand, {M}. {A}. and {A}rifi, {F}. and {M}anochehr, {M}. {H}. and {S}afi, {N}. and {H}adad, {A}. {S}. and {R}ahmanzai, {A}. {J}. and {Y}aqubi, {G}. {S}. and {R}idde, {V}al{\'e}ry},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {I}n response to the high maternal mortality in {A}fghanistan, the government emphasised enhancing antenatal care ({ANC}) coverage to improve skilled birth attendance and reduce maternal mortality. {T}his study aimed to explain how and why {ANC} interventions worked, for whom, and under what circumstances in {A}fghanistan between 2000 and 2024.{M}ethods {A} rapid realist review was conducted to identify underlying programme theories and examine contextual factors and key mechanisms influencing {ANC} outcomes, with input from a panel of national experts. {D}ata were extracted using context-mechanism-outcome ({CMO}) configurations to develop and refine theories for policy recommendations.{R}esults {F}rom 3502 papers, 1860 duplicates were removed, 63 were screened for full text and 25 were included in the final review. {I}n total, 29 {CMO}s were inferred across nine interventions, classified at individual, interpersonal, community and institutional levels. {W}e found that {ANC} interventions could work best by empowering women and healthcare workers ({HCW}s), involving husbands, hiring female community health workers ({CHW}s), ensuring regular contact with the same {HCW}s, endorsing health messages by the government, incentivising {CHW}s and designing and implementing interventions using participatory approaches. {I}nterventions are less successful when there is a lack of community trust in service quality or {HCW} qualifications, low decision-making ability among women, discomfort during travel to health facilities, adherence to traditional practices and beliefs, hiring {CHW}s from outside the community, chronic stress and lack of support among {HCW}s and unrecognised incentives.{C}onclusion {O}ur evidence synthesis can inform donors, policymakers and implementers on how to design more effective {ANC} interventions to achieve better health outcomes in {A}fghanistan. {B}y emphasising intervention evaluation and {ANC} quality improvement, it highlights the importance of key social elements, such as cultural norms, power dynamics, relationships, beliefs and trust, which are likely to maximise impact. {C}ommunity involvement is essential for designing and implementing effective and sustainable {ANC} interventions.},
  keywords = {{H}ealth {S}ervices ; {H}ealth policy ; {P}regnant {W}omen ; {R}eview ; {A}ntenatal ; {AFGHANISTAN}},
  booktitle = {},
  journal = {{BMJ} {O}pen},
  volume = {15},
  numero = {11},
  pages = {e102454 [15 p.]},
  ISSN = {2044-6055},
  year = {2025},
  DOI = {10.1136/bmjopen-2025-102454},
  URL = {https://www.documentation.ird.fr/hor/fdi:010095516},
}