Effectiveness of culturally appropriate antenatal education packages to improve birth preparedness and complication readiness in low- and middle-income countries: a systematic review.

BACKGROUND

Birth preparedness and complication readiness (BPCR) remain essential components of maternal survival strategies in low- and middle-income countries (LMICs). Suboptimal antenatal education contributes significantly to delayed recognition of obstetric danger signs and late care-seeking. Delays in recognising obstetric danger signs and seeking care contribute to high maternal mortality in LMICs. Culturally tailored antenatal education packages have been increasingly used to improve BPCR; however, evidence across LMICs has not been systematically synthesised.

OBJECTIVE

To synthesise evidence on the effectiveness of culturally appropriate antenatal education interventions on BPCR outcomes among pregnant women in LMICs.

METHODS

This systematic review adhered to PRISMA 2020 and JBI guidelines. We searched PubMed, Scopus, Web of Science, CINAHL, AJOL, and Google Scholar (January 2015-July 2025) for English-language studies on antenatal education interventions reporting BPCR outcomes in LMICs. Two reviewers screened titles/abstracts, assessed full texts, appraised quality (JBI checklists), and extracted data for narrative synthesis due to heterogeneity.

RESULTS

Eleven studies (n = 5,802; quasi-experimental n = 4, cross-sectional n = 4, cohort n = 2, community-based n = 1) from Ethiopia (3), Nigeria (3), Tanzania (2), Cameroon (1), Kenya (1), Bangladesh (1) showed consistent improvements: danger sign knowledge up to 85% (mobile SMS, Tanzania), BPCR practices 25-95% (e.g., goal-oriented education, Nigeria: 65.5% to 95.3%), institutional delivery 53.5% to 93.5%. Predictors include early ANC, partner involvement and local languages. Quality: low-moderate risk of bias.

CONCLUSIONS

Culturally matched antenatal classes help pregnant women in low-income countries better prepare for childbirth and emergencies, improving knowledge by up to 85% and care-seeking behaviour by 25-95%. This review of 11 studies supports the use of local languages, family involvement, and phone messages in routine prenatal care to save lives. More high-quality trials are needed.