Neonatal mortality rates on decline

These community groups provide a cost-effective intervention along with benefits such as reducing significantly maternal depression and improving decision-making amongst poor women. Annually, an estimated four million children across the world die within the first month of their lives.

A previous study carried out in Nepal in 2004 suggested that participatory women’s groups could achieve a significant impact on neonatal health in poorer countries, far more than one-to-one contact with a health worker. In order to find out if these findings could be applied in other countries, the researchers repeated the exercise in Jharkhand and Orissa. Neonatal mortality rates in the two regions are 49 and 45 per 1,000 live births respectively, much higher than India’s national estimates of 39 per 1,000. By comparison, in Britain the figures are four per 1,000.

Maternal depression

Between 2005 and 2008, a team of researchers led by Anthony Costello, University College London, and Dr Prasanta Tripathy, from the Indian voluntary organisation Ekjut, assessed how women’s groups affected neonatal mortality and maternal depression in intervention areas as compared to areas where no participatory groups were set up.

The groups were evaluated using a cluster-randomised controlled trial. The groups were facilitated by women recruited in the local area, non-healthcare professionals who were mostly married, with some schooling, and a respected member of the community. The number of women taking part in the groups increased from one in six women (17 per cent) of childbearing age in the first year to over a half (55 per cent) in the third year.

The women worked through a ‘community action cycle’ consisting of four stages: identifying the problems linked to pregnancy, childbirth and care of newborns; developing strategies to tackle these problems, such as improving hygiene, raising emergency funds and producing their own birthing kits; working with local community leaders, teachers, politicians and others to implement these strategies, and; evaluating their success.

Dr Nirmala Nair, Ekjut, said: “It was crucial that the women were allowed to think through the issues and implement their own strategies to tackle them, rather than us telling them what to do. We believe that a trained facilitator who supports informed peer learning is more effective for lasting behaviour change than a traditional instructor/learner approach.”

The results of the interventions were remarkable: by the second and third years of the trial, the neonatal mortality rate in the areas where the participatory women’s groups existed had dipped by 45 per cent. These areas also saw a 57 per cent  fall in moderate depression amongst mothers by the third year of the trial.

Costello said: “What we were seeing was a change in behaviour towards better hygiene practices and improved care for newborns”. “There was a move away from harmful practices such as giving birth in unclean environments and delaying breastfeeding. We saw significant improvements in areas such as basic hygiene by birth attendants, clean cord care and women responding earlier to care needs.”

Dr Audrey Prost, UCL, said: “Many of the women in these groups would have been relatively young, living in arranged marriages with only their mother-in-law or a very limited network of friends for support”. “If you’ve been to a group and a problem arises, you’ve got a ready-made network that you can go to for help and support.”

The researchers estimate that the additional cost on introducing support to these groups per newborn life saved was around $910. Whether Central or state government, non-governmental organisations, or a combination of the two would pay for supporting these groups is still a question.

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