Developing women's confidence can help reduce deaths among newborn babies by up to 30 per cent / Tom Pilston - Panos pictures
A new report claims that women’s groups in Nepal have helped to cut deaths among mothers and newborn babies. The study suggests that developing women’s confidence, and encouraging them to share what they learnt in their communities helped to reduce deaths among newborn babies by up to 30 per cent in the Makwanpur district of central Nepal.
“Our findings suggest that community mobilisation interventions using women’s groups can improve maternal and newborn health in areas that are resource poor,” explains one of the authors of the report, Joanna Morrison, a senior research fellow at the Centre for International Health and Development at University College London’s Institute of Child Health.
Nepal has one of the highest mortality rates of newborn babies in Asia at 33 per 1000 live births, accounting for three quarters of the country’s infant deaths and more than half of deaths among under-fives, according to the report.
From 2001 to 2003 the researchers found a 30 per cent reduction in neonatal mortality and a “substantial” reduction in maternal mortality compared with control areas. The study, which aims to explain the reasons for this reduction, was published in this month’s International Health Journal.
Confidence and knowledge boost
Health workers reported an increase in knowledge about hygiene. One health worker told researchers: “Group members have helped villagers understand that dirty things affect them. They have even told the villagers to keep clean bedding before delivery.”
However, also key to success was improved confidence among the women and a desire to spread the information they learnt.
A community leader told researchers: “They [women] were eager to know about things and they were not hesitating to discuss their problems. Those women, who didn’t talk to about their problems before, were interacting with each other.”
Another woman said: “(Women) should come out of the house and learn things. Whatever we know, we should tell others. We need to share with each other.”
“Participatory approaches [such as women’s groups] recognise and value local knowledge and awareness and do not consider that community members need to be taught in a top down way, by experts,” says Ms Morrison.
The intervention methods used in the groups were “based on the ideas of Paulo Freire who argued sustained social change is only possible if teachers and learners engage in a dialogue, exchanging ideas and experiences,” according to the report.
The researchers compared 11,184 women who had recently given birth with women’s group members in an earlier study in 2001-2003.
“In this context, there are many barriers preventing women from accessing maternal and newborn health care [such as] topography of the area, perceptions about the cost of care, lack of trust in local health facilities and preference for care from traditional healers are some of the factors preventing health care access”, explains Ms Morrison.
Breaking down barriers
The researcher held focus group discussions and group interviews with women’s group members and facilitators, men, mothers-in-law and community health care providers. The researchers also asked interviewees to take photographs (a term referred to as photo elicitation) on three subjects: health, MIRA (Mother and Infant Research Activities) and the social environment. The researchers used photographs to help eliminate bias in answers and also to overcome uneasiness in discussing sensitive issues.
“Using photo elicitation broke-down a lot of communication barriers,” explains Ms Morrison. “By using this method, we had to keep visiting respondents in their homes (to give cameras, to retrieve cameras, and then to have the discussion), so they got to know and trust us.”
Lack of trust
According to the report, none of the participants chose to take photographs of government health care services when asked to photograph something to do with “health”. When the researchers asked further questions, they found that many of the interviewees had little trust in government health care providers. Many felt that the health personnel lacked expertise and training. In addition, political instability in the country during the study period affected the women’s trust in healthcare services.
“Management committees of health facilities were often not functioning well during the time of the study due to the political insurgency, which suppressed civil society participation, and participation in the planning and implementation of many public services,” Ms Morrison explained.
Title: Understanding how women’s groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study
Authors: J Morrison, R Thapa, S Hartley et al