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Base de datos de evaluación

Evaluation report

BHG 2000/011: External Evaluation of the Project 'Schools for Pregnant Women'

Author: Smith, N.; Wexford, H.

Executive summary


A pilot School for Pregnant Women (SPW) project was introduced in four towns in the Federation BiH between October and December 1998 as a co-operative effort between the Federal Public Health Institute and UNICEF. Its success led to expansion into other locations, with adjustments to the programme. The project was started in Republika Srpska in June 1999, as a co-operative effort between the Ministry of Health and Social Welfare and UNICEF. Internal reports on the project were very positive and supported its continuation.

The SPW are a series of antenatal classes to which pregnant women are invited, free of charge, and which they attend on clinic premises. The curriculum covers nutrition and lifestyle for a healthy pregnancy, risks of pregnancy, psychophysical preparation for labour, breastfeeding, infant care, and sexually transmitted diseases. There are currently 21 schools supporting 1,070 pregnant women.

Purpose / Objective

The purpose of the evaluation was to assess the impact, methodology, sustainability and future development of the School for Pregnant Women (SPW) project.


The evaluators used interview and observation, in conjunction with information provided in the background papers. A qualitative methodology was used for interviews.

Outline schedules of questions were developed prior to arrival, which provided a framework for interviews. In practice, much adapting of the outline schedules took place, with questions changing in response to themes that emerged from interviewees. Interviews were either tape-recorded or notes were made. Anonymity was promised to user interviewees. Six out of the 21 centres were visited. Two interviews were conducted with government representatives (the Deputy Minister of Health in the Republika Srpska, Prim Dr. Milos Bajic, and the Director of the Federal Institute of Public Health, FedBiH, Prim Dr. Zlatko Vucina. There were also interviews with: 1 assistant director, 3 directors, 12 educators, 16 pregnant women, 4 expectant fathers, and 10 postnatal women.

Nine teaching sessions were observed (seven lectures and two exercise sessions). Three teaching videos were seen either during or outside a class.

Key Findings and Conclusions

The findings highlight the success of SPW so far in raising awareness of appropriate healthcare during pregnancy, preparation for labour and birth, care of the newborn, and breastfeeding. Attendance numbers are increasing and news of the schools is spreading by word-of-mouth. Attendees pass on information to others so the impact of the schools is greater than can be measured by attendance numbers.

Educators were enthusiastic about the schools and showed great commitment to them. They are adapting material to meet local needs and find the schools a useful way of conveying important information regarding pregnancy, birth and infant care since antenatal clinics are too busy to allow this to be done adequately. Doctors in more isolated areas are able to make better contact with pregnant women through the schools. Women who have been prepared cope better in labour and are less afraid. Breastfeeding promotion is better achieved through the schools.

Women, both pregnant and postnatal, were extremely pleased with the effects of the school. Knowledge had increased and behaviour had altered as a result, particularly in the areas of nutrition and giving up smoking. The team received background documentation, which included the survey of mothers' knowledge before and after the school. It appeared from the results of this survey that awareness has been raised in many aspects. The physical preparation for labour had been greatly appreciated and was one of the things that most attracted women to the school. The support for the continuation of the project was overwhelming. Three expectant fathers interviewed were also very positive about the schools, even though they were very much in the minority as attendees.

Education on breastfeeding was found very helpful, and was supported after birth by the Baby-Friendly hospitals and other health professionals.

The findings also showed that women accessing the schools tended to be better educated and less isolated than those who did not. Educators felt a great need to extend the schools to reach more women, particularly those living in villages. Attendees at the schools frequently found that the teaching on early pregnancy had come too late for them and no longer seemed relevant. More physical preparation for labour was wanted. Accommodation for the classes was not always suitable, or not used in the best way.

In the classes observed, the teaching methods were traditionally didactic, a reflection of accepted educational practice. Time was allowed for questions but groups were not particularly responsive at the time. Physical exercise was sometimes taught in a way that was very strenuous and not the most beneficial to pregnant women. There is a lack of knowledge of how to use all donated equipment for exercise. No particular allowances are made for the needs of the men who are present and the men interviewed would have liked some content aimed at fathers.


Ensuring all pregnant women who attend the clinics know how to access the schools is a priority. Attending to the comfort of pregnant women attendees is recommended. Monitoring formally how women hear about the schools is also important, since money is being spent on TV advertising.

Further training of educators is important in adult teaching methodology, physical exercise and use of equipment. A national network of educators to exchange ideas and offer support needs to be established. Greater access to international trends in antenatal education is required, especially since educators feel a lack of this currently.


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Report information





Education - Non Formal

United Kingdom National Committee for UNICEF, Government of the Netherlands, Government of Japan, US National Committee for UNICEF, German National Committee for UNICEF, Ministry of Health and Social Welfare, Republika Srpska, Federal Institute of Public Health, Federation of Bosnia and Herzegovina


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