Twenty-five poor and illiterate women from a rural village in Bangladesh sit together in a courtyard. A lively discussion is taking place as the women recount stories of marriage, pregnancy, birth and motherhood. Over the coming months, these women will be learning about how they can improve their and their babies’ health and will be involved in planning and implementing low-cost solutions to improve the lives of mothers and babies in their community.
Shenaz had been attending the group, when she developed pre-eclampsia during her pregnancy. She recognized the signs that had been discussed during the group and says, “Perhaps my daughter and I would not be alive today if our group members hadn’t convinced my family to admit me in the hospital. I will be grateful to our women’s group members forever.”
Maternal and newborn health: a global picture
Maternal and infant mortality in low income countries remains high and continues to pose significant challenges to health systems globally. Sub-Saharan Africa and south Asia bear the greatest mortality burden. An African woman has a 100 times greater lifetime risk of dying from pregnancy-related causes than that of a woman in a high-income country (Save the Children 2013) and 40percent of child deaths occur in the first month of life in low-income countries (World Health Organization & UNICEF 2013).
Policy initiatives such as the Safe Motherhood Initiative and more recently the Millennium Development Goals 4 and 5, have seen some success in improving the lives of the poorest mothers and babies. However, with the Millennium Development Goal deadline of 2015 drawing close, there is still a long way to go in the poorest nations of the world.
Although there’s no doubt that health systems in the poorest countries need to be strengthened, there also needs to be a demand for such services. Under-use of existing health care services may be due to many complex social, religious, economic and cultural factors, which could result in delays in deciding to access health care, getting to a health facility and the provision of appropriate treatment. Interventions at the community level can not only help to create an increased demand for health care, through raising awareness of the benefits and importance of accessing health services, but also provide much needed self-help measures for mothers and their babies in their home environments.
Improving maternal and newborn health through women’s groups
Over the past ten years, Women and Children First (UK) has developed an approach which has seen tremendous success in improving the lives of mothers and babies in parts of rural Africa and Asia, with the aim of encouraging women to seek institutional care (for antenatal care and birth) as well as raising awareness of home-based preventative measures and support. Through developing a model of participatory women’s groups, women have been empowered and their communities mobilised in order to reduce maternal and infant mortality using low-cost and sustainable interventions. Although the work of Women and Children First (UK) is focussed around these women’s groups, elements of strengthening local health services are often built into projects as well, such as providing refresher training to nurses and midwives.
The process for setting up and running women’s groups starts when a community is indentified who are interested and motivated in running such groups. The groups have had a greatest impact when run in communities known to have low access to health services and high maternal and newborn mortality rates. As well as working with the community to establish women’s groups, it is often also necessary and beneficial to engage with government officials, religious leaders, and village elders . In Ntcheu district in Malawi, the women’s groups have the support of the Group Village Headmen. They have ensured that women from all of the villages, not just those that are officially part of the project, are encouraged to attend the groups.
Each women’s group is run by a group facilitator – identifying and training the right person for the role of facilitator is crucial to the success of the group. The facilitators are literate women (preferably a mother themselves) who live within, and understand the community, as well as have an ability to communicate, motivate and listen.
When the women gather to meet in their groups, they follow a participatory learning and action cycle, which takes approximately two years to complete. The cycle includes identifying and prioritising maternal and newborn health problems, identifying local strategies to address these problems, acting on the local strategies and finally evaluating their impact. Throughout the life cycle of the group, women discuss different topics on infant and maternal health that are of interest to them. The majority of women attending women’s groups have low literacy levels so methods of contextually communicating such as storytelling, role plays, the use of picture cards and song and dance have been found to be particularly effective. The great strength of using this model is that women often for the first time, have their opinions heard and are given a voice.
Through women identifying solutions to the challenges faced in their own communities, the groups have been able to develop low-cost solutions demonstrating the ability of a community to take control in addressing maternal and newborn health issues. Examples of this include a system of village savings and loans to help women pay when medical intervention is required, bicycle ambulances to transport women to the nearest health care facility, and video shows to raise awareness of maternal and newborn health issues.
Additionally, many groups have established positive links between themselves and their local health services. In Jharkand, India, health committees were formed to support the community to input into the design and management of health services, which in turn resulted in those same community members becoming part of the government-led village health committees. In other areas, community health workers have been invited to the groups to talk about delivery kits and how to use them.
Although mobilising communities to improve maternal and newborn health through women’s groups is no quick fix solution, there is a strong and growing evidence base supporting their positive impact on maternal and newborn health as well as demonstrating cost-effectiveness.
Urgent action is required in order to improve the lives of mothers and babies in the world’s 75 poorest nations in which 95 percent of all maternal and child deaths occur. This model of participatory women’s groups is an evidence-based and cost-effective intervention that has been shown to reduce maternal and newborn mortality rates in rural resource-poor settings.
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Adapted from an original article by Esther Sharma published in MIDIRS June 2014.
Featured image photo credit: GAIN, Flickr Creative Commons