Communities of Care

Given the high emotions, logistical preparations, and joy of welcoming a baby into the world, it might be easy to forget that pregnancy remains a risky endeavor for women across the globe. According to the World Health Organization, in 2023, over 700 women died every day from preventable causes related to pregnancy and childbirth. That same year, systemic issues in lower-middle-income countries contributed to 92 percent of global maternal mortality, with Sub-Saharan Africa and southern Asia accounting for 87 percent of those deaths. Despite spending the most per capita on healthcare in the world, the U.S. reported the highest maternal mortality rate of any high-income country, with a disproportionate impact on Black and Indigenous women. 

Theresa Norpeli Lanyo is a Rackham Ph.D. candidate at the U-M School of Nursing who decided to pursue her doctoral degree, after 11 years of midwifery in her home country of Ghana, to address some of the barriers to adequate prenatal care.

“As a midwife, a nurse, and as a healthcare researcher, I want to make sure that women go through pregnancy safely, have the best experience, and do not die from preventable causes, both here in the U.S. and globally—and also make sure that our babies are born safely,” Lanyo says.

In Lanyo’s experience, the factors that contribute to high maternal mortality rates in Ghana are systemic in nature and require an interpersonal, communal approach. In her most recent co-authored paper, which she presented at the 2025 International Federation of Gynecology and Obstetrics Congress in Cape Town, South Africa, Lanyo details the positive outcomes for pregnant women in the Eastern Region of Ghana who participated in prenatal groups from September 2018 to August 2024.

In the prenatal care described in Lanyo’s paper, pregnant women with similar due dates are placed into groups of eight to 10, with attention to how many babies the women have already delivered, allowing first-time moms to learn from the experiences of those who have been through it before. While a nurse midwife convenes the group and facilitates conversations about prenatal health, the group sits in a circle, and equality amongst all the group’s members is emphasized. This work was part of a bigger cluster randomised control trial conducted in Ghana by Lanyo’s mentor Dr. Jody Lori.

“People talk about their experiences, there is peer-to-peer support, and healthcare provider-to-patient support in each session. There is this intimacy, and there’s this community of feeling so you don’t feel alone,” Lanyo says. 

Participants in prenatal groups forge meaningful relationships that extend beyond the boundaries of the healthcare setting through WhatsApp groups where they regularly communicate and check on each other. 

“Even if you do not have a community, you have others who are peers who are ready to help you. And then you also have easy access to your healthcare provider who is ready to talk to you, counsel, or help you in any way they can,” Lanyo says.

In Ghana, Lanyo cites patriarchal societal structures and religiosity baked into common attitudes about medical care as some factors that contribute to the nation’s high maternal mortality rate—factors that could be addressed with support within the female-dominated, communal context of prenatal care. 

Reflecting further on past patient experiences, Lanyo recalls an adolescent patient who was showing cardinal signs for preeclampsia during a routine checkup, a serious pregnancy complication where the mother’s blood pressure can rise to fatal rates for herself and her baby. The patient was asked to come to the hospital for admission, but she did not come. Tragically, the patient and her baby died. 

“If she had come on admission, as was instructed, she should have made it. She didn’t have the health literacy to know the severity of her problem,” Lanyo says. “She was also very young, very naive, and didn’t have mature people around her to help. She would’ve benefited from the more experienced mothers in a prenatal group community.”

Across the board, pregnant women who participated in group prenatal care received improved healthcare versus the control group, with women reporting feeling more respected than those in the control group (93.5 percent to 83 percent); women experiencing reduced waiting times to see a healthcare provider (92 percent to 81 percent); and women receiving breastfeeding educational support (95 percent to 87 percent). 

Lanyo also describes prenatal groups as a way to meet women halfway in their own cultural contexts, empowering them to make informed choices about their own bodies and creating a supportive, dignified environment for them to thrive. 

“Respect is a basic concept that goes a long way to improve health outcomes,” she says.

As she prepares for the next chapter of her life, Lanyo’s vision for herself and her patients is vast: “I want to use my clinical experience, research my observations, and translate them into real-world settings,” she says. “I want to influence policy and make radical changes to help women.”