Two articles published Online First in The Lancet report that community support groups can reduce neonatal mortality. In addition, they can lower rates of maternal depression, provided that the population coverage is wide enough and the programs are suitably designed.
In trials in Nepal, participatory women’s groups have shown promise. Neonatal mortality was reduced by about one-third. Two research teams undertook to test this approach further. They carried out cluster-randomized controlled trials that were led by Anthony Costello, University College London Centre for International Health and Development, Institute of Child Health, London, UK.
Prasanta Tripathy, Ekjut, Chakradharpur, Jharkand, India and colleagues explain their work in the first article. They assigned clusters in a population of 228,186 people in Jharkand and Orissa in eastern India to either participating in women’s groups focusing on the reduction of maternal and newborn health problems, or not. A total of 19,030 births were monitored over 3 years. They found that neonatal mortality was 32 percent lower overall. It was 45 percent lower in years 2 and 3 for women who had been living in areas where women’s groups existed than for those who had not. Moderate maternal depression had fallen by 57 percent by the third year.
The authors explain: “Women’s groups led by peer facilitators reduced neonatal mortality rates and moderate maternal depression at low cost in largely tribal, rural populations of eastern India. The most likely mechanism of mortality reduction was through improved hygiene and care practices.”
They write in conclusion: “Participatory groups have the advantage of helping the poorest, being scalable at low cost, and producing potentially wide-ranging and long-lasting effects. By addressing critical consciousness, groups have the potential to create improved capability in communities to deal with the health and development difficulties arising from poverty and social inequalities.”
Professor Kishwar Azad, Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh and colleagues describe their work in a second article. They monitored neonatal mortality for 36,113 births over 3 years in a population of 503,163. As with Tripathy et al’s study, the study population was divided into clusters. Some of which were assigned to support from women’s groups. Findings indicate that the community support made no difference to neonatal mortality rates.
They comment: “For participatory women’s groups to have a significant effect on neonatal mortality in rural Bangladesh, detailed attention to programme design and contextual factors, enhanced population coverage, and increased enrolment of newly pregnant women might be needed.”
They note: “Women’s groups, if scaled to an adequate coverage, have the potential to reach the poorest people and bring about substantial health and non-health benefits. Nonetheless, a women’s group approach requires adequate human resources support for community mobilisation and appropriate coverage.”
“Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial”
Kishwar Azad, Sarah Barnett, Biplob Banerjee, Sanjit Shaha, Kasmin Khan, Arati Roselyn Rego, Shampa Barua, Dorothy Flatman, Christina Pagel,Audrey Prost, Matthew Ellis, Anthony Costello
DOI: 10.1016/S0140-6736(10)60142-0
The Lancet
Written by Stephanie Brunner (B.A.)