Madagascar

The country’s first public antenatal class

Key numbers

3

Regions, in the Ministry’s health centres.

103

Birth preparation sessions organised.

Maternal and neonatal health remains a major concern in Madagascar. Maternal and neonatal mortality rates are alarming; pregnant women do not seek sufficient healthcare and lack knowledge about the risks associated with pregnancy and newborn care. That is why Children of the World has developed the country’s first childbirth preparation classes in public health centres, with the support of the local association FISA.

Integrating birth preparation into the Madagascan healthcare system

We have been working since 2024 with the Madagascan Ministry of Public Health to integrate birth preparation into the health system on a long-term basis. Following a pilot phase, the antenatal course we have developed was officially approved by the Ministry in 2025 and is now included in the national sexual and reproductive health standards, which guarantees its long-term adoption.

It is being rolled out in three regions: Analamanga, Atsimo-Andrefana and Diana (health districts of Antananarivo North, Tulear and Ambanja).

Improving the knowledge of expectant mothers

Childbirth preparation classes, led by trained midwives, give expectant mothers and their partners the keys to a safe pregnancy and delivery.

They cover:

Recognising danger signs (fever, bleeding, convulsions) and what to do.

Preparing for childbirth: location, things to bring, organising transport and family support.

Practical advice on nutrition, hygiene, mental health and breastfeeding.

Simple exercises for breathing, relaxation and prenatal gymnastics to reduce stress and better prepare the body.

Each participant receives an illustrated booklet in Malagasy and French, which can be used as a guide at home to repeat the exercises and share information with the family.

These sessions, which are appreciated for their reassuring and interactive nature, strengthen the bond between women, their loved ones and healthcare professionals.

Improving the training of healthcare personnel

We train midwives to lead the classes, using a simple guide with illustrations adapted to the Malagasy context to facilitate the transmission of health knowledge, especially to illiterate women.

Since 2025, the strategy has been expanded to include community health workers in order to raise awareness among women living far from health centres.

The activities are carried out by the NGO FISA Madagascar, the Ministry of Health, the Ambanja District Reference Hospital and Terre Innovative Healthcare S.r.l..

Our Impact

95% of participants consider the courses to be highly relevant and useful.
100% of participants can name at least three warning signs, compared to only 40% of women who have not taken the programme.
The programme enjoys national recognition and strong commitment from the Ministry, ensuring its long-term integration into the health system.
Partners and families, including spouses, are also involved: more than 70% of male participants report having a better understanding of how to support their partners.
90% of participants say they have applied at least one recommendation from the classes at home (preparation for childbirth, organisation of affairs, follow-up of prenatal appointments).

Saïra, six months pregnant

This course gave me peace of mind and changed my view of what a pregnant woman can do. And it’s better to come to the hospital to get answers to our fears so we don’t do anything stupid.