01 · What breaks
Design for the failure modes, not only the happy path.
Pregnancy tracking runs on a fixed clock with real stakes. A missed check-up or an unfollowed referral can matter within days, and a careless message can reveal a pregnancy the woman has not chosen to share.
Duplicate pregnancies across workers
A woman registered by one worker in her marital home and again at her mother's house in late pregnancy appears as two cases, each with gaps. Check duplicates on her name, a family member's name, age and due date, and let workers transfer a pregnancy rather than open a new one.
Risk alerts without response capacity
Flagging every woman with one abnormal reading can produce more high-risk alerts than the nearest facility can see. Agree with the medical officer which signs need same-day action and which can wait for the next session, and who responds to each. Then size the alert rules to that capacity.
Estimating clinical status from incomplete data
If a haemoglobin value is missing, the system should show it as missing, not assume it is normal. Derived fields such as gestational age depend on how the date was estimated. Show the source beside each calculated value, and never label a pregnancy low risk because tests have not been done.
Unsafe disclosure on shared phones
A reminder that an antenatal check-up is due, sent to a shared family phone, can disclose a pregnancy early, or a loss, to people the woman has not told. Ask her preferred contact method and timing, keep message text neutral, and stop all reminders the moment a pregnancy ends.
02 · Minimum viable model
Hold one pregnancy record from registration to postnatal closure.
Maternal care moves between home, sub-centre and hospital, and between community workers, ANMs and doctors. These six records keep one pregnancy visible across those handoffs, with the next due action always clear.
| Reference (as of October 2026) | What it says | How to model it |
|---|---|---|
| WHO antenatal care guidelines, 2016 | A minimum of eight contacts during pregnancy | Hold the contact schedule your programme follows in a reference table, so it can change without rebuilding forms |
| National Health Mission norm | At least four antenatal check-ups, the first in the first trimester | Flag registrations made after the first trimester, and count facility check-ups separately from home visits |
| Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) | Free, comprehensive antenatal check-ups at government facilities on the 9th of every month, or the next working day | Generate a monthly list of women due a check-up a few days before the 9th, for mobilisation |
| Mother and Child Protection (MCP) Card | A paper card issued jointly by MoHFW and MoWCD to every registered pregnant woman, covering antenatal, delivery, postnatal, immunisation and growth services | Note whether she holds the card and use it as the shared reference with the family |
| ANMOL and the RCH Portal | ANMs enter and update records of pregnant women in the RCH Portal through ANMOL, which works offline | Store the government registration reference where the woman agrees, and reconcile rather than re-enter |
Schedules and scheme rules change. Confirm the current guidance with your medical adviser and the district health team before the system uses it to generate due dates or reminders.
03 · Implementation sequence
Move through reviewable gates.
Agree the clinical definitions with a medical adviser first, then build the timeline, reminders and escalation, testing each with real field teams. A pregnancy system earns trust when its due dates match the ANM's.
Agree timeline and service definitions
With a medical adviser, write down how gestational age is estimated, which contacts count as an antenatal check-up, which danger signs trigger a referral and what counts as a completed postnatal visit. Store these as reference tables with a version and a date, and have every report cite the version it used.
Link home and facility identity
Record the identifiers that let you match your record with the facility's: the MCP card, the government registration reference where shared, the facility name and the ANM's area. Matching on name alone fails for common names. Agree a match rule, and have a person resolve uncertain matches.
Schedule contacts and referrals
Generate due dates for home visits and facility check-ups from the estimated due date, and recalculate them when a scan changes the estimate. Each referral carries the facility, urgency and a target date, and stays on the worker's list until it is confirmed or a supervisor closes it.
Test urgent escalation
Before go-live, run drills with anonymised scenarios: bleeding at night, severe headache with high blood pressure, no transport available. Check that the alert reaches a named person, that the fallback works when they do not answer, and that workers know to call the local emergency number without waiting for the app.
Reconcile facility confirmation
Each month, compare your record of check-ups and deliveries with the ANM's or the facility register. Differences go to a short list for the supervisor: a check-up missed, a delivery recorded elsewhere, a woman who moved. Correct the record and note the source instead of overwriting silently.
Review maternal and newborn follow-up
Monthly, the programme lead reviews women past their due date with no birth outcome, postnatal visits not done and newborns without follow-up. After a miscarriage, stillbirth or transfer, a supervisor closes the record with a reason, and every reminder stops at once.
04 · Evidence
Measure whether the work became clearer.
Count timeliness, not only totals: a check-up in the third trimester does not make up for a missed first one. Review these with supervisors monthly and, where possible, with the facility. The maternal and child health playbook covers the wider programme.
05 · Responsible automation
Let systems prepare. Keep consequence with people.
Systems can support
- Due-date and contact schedules
- Referral tracking to facility confirmation
- Monthly reconciliation lists
- Neutral reminders that stop on closure
People should decide
- Clinical risk assessment
- Emergency response
- Changing the care plan
- Closing a pregnancy record after loss or transfer
06 · Common questions
Practical questions teams ask.
Questions maternal health teams ask when replacing paper registers with a tracking system.
What should a pregnancy and ANC tracking system record?
One record per pregnancy with the estimated due date and how it was estimated, each antenatal check-up and home visit as a dated event, risk observations with their values, referrals with facility and urgency, the birth outcome, postnatal visits and newborn follow-up. It should also hold the identifiers needed to match the record with the government health record.
How many antenatal check-ups should the system schedule?
Schedule what your programme and district follow, and keep it in a table you can change. WHO's 2016 guidance recommends at least eight contacts, while the National Health Mission norm has been at least four check-ups, starting in the first trimester. Confirm the schedule with your medical adviser and district health team before it drives reminders.
Can a nonprofit system replace the ANMOL or RCH record?
No, and it should not try. ANMs record pregnancies in the government RCH Portal through ANMOL. A nonprofit system works best as a companion that supports its own field teams, mobilisation and follow-up, matched to the government record where the woman agrees. Reconcile differences monthly instead of asking frontline staff to enter everything twice.
How should high-risk pregnancy alerts work?
Agree with a medical officer which danger signs need same-day action, which can wait for the next session and who responds to each. The system then sends the alert to that named person, with a fallback if they do not respond in time. Alerts should prompt trained staff to act, never stand in for a clinical assessment.
How do you close a pregnancy record after a loss?
Carefully, and through a supervisor. The worker records the event, the supervisor confirms and closes the record with a reason, and every scheduled reminder stops immediately. Offer support or a referral if the woman wants it. Keep the record restricted, and make sure no automated message about check-ups or the baby goes out afterwards.