Limitations
Implementation of the group ANC intervention and the ensuing process evaluation were impacted by the pandemic, as described above. However, the research team in Ghana and the midwife facilitators were committed to the program success. Fortunately, most of the group meetings were held outside which limited risk of COVID transmission and participants and midwives were required to wear masks during the meetings. While attempts were made by the midwives and research assistants to reach who stopped attending meetings, we do not have data on reasons for discontinuation and can only speculate that while some miscarried or moved, others may have not enjoyed or been dissatisfied with group antenatal care.Process evaluations are increasingly incorporated into health intervention research, providing value by documenting the barriers and facilitators of the intervention components [