Effect Of A Participatory Intervention With Women’s Groups On Birth Outcomes And Maternal Depression In Jharkhand And Orissa, India: A Cluster-Randomised Controlled Trial
Women’s groups led by peer facilitators reduced neonatal mortality rates and maternal depression in tribal, rural populations of eastern India.
Every year, an estimated 3.7 million children die worldwide in their first month of life. About 800 women die daily from childbirth and pregnancy, and 99% of these deaths occur in developing countries. Maternal and child mortality remains an urgent global challenge. India, in particular, accounts for 20% of maternal deaths worldwide, 21% of deaths for children under the age of 5, and 25% of all neonatal deaths. Urgent efforts are needed to reduce these mortality rates quickly through cost-effective and scalable interventions.
Interventions that have shown promising results in Bolivia and Nepal in reducing neonatal and maternal mortality are participatory women’s groups, in which participants identify the causes and problems that lead to maternal and newborn deaths, develop practical strategies with community leaders and men, and implement and assess the outcomes of these strategies. This study examines the effect of women’s groups on neonatal mortality and maternal depression in two states in Eastern India: Jharkhand and Orissa. These states are two of the poorest in Eastern India, with 40% of the population living below the poverty line and with an illiteracy rate of 63%. The women’s groups met monthly for a total of 20 meetings, which were facilitated by a trained local woman. Information about clean delivery practices and care-seeking behavior was shared through stories and games, and group members identified and prioritized maternal and newborn health problems in the community, collectively selected relevant strategies to address these problems, implemented their strategies, and assessed the results.
The intervention led to a decrease in neonatal mortality and improvements in home-care practices following delivery:
- At baseline, the neonatal mortality rate was 58 per 1,000 live births. In 3 years, women’s groups decreased the neonatal mortality rate by 32%, compared with communities without women’s groups.
- The maternal mortality ratio at baseline was 510 per 100,000 live births. The trial was not powered to detect a reduction in maternal mortality due to the need of a larger sample size. For more information on maternal mortality, further research has been conducted on women’s group interventions in 2013.
- There was not a significant effect on maternal depression overall, but in year 3, when a larger share of women joined the groups; there was a 57% reduction in moderate depression among mothers in the intervention areas relative to the control areas. .
- Although women who participated in women’s groups were not more likely to seek health care, their home-care practices improved: in treatment areas, birth attendants were more likely to wash their hands, use a safe delivery kit and a plastic sheet, and boil the thread used to tie the umbilical cord.
Women’s groups led by peer facilitators reduced neonatal mortality rates and moderate maternal depression in rural populations of eastern India.
The researchers divided Jharkhand and Orissa, India (with estimated populations of 228,186) into 18 clusters for the intervention and 18 clusters for the control using stratified randomization. Women were eligible to participate if they were 15-49 years old, resided in the project area, and had given birth during the study. Working with 244 groups in treatment clusters, a facilitator convened thirteen women’s groups every month to support participatory action and learning for women, and facilitated the development and implementation of strategies to address maternal and newborn health problems. Information about clean delivery practices and care-seeking behavior was shared through stories and games, and group members identified maternal and newborn health problems in the community, collectively selected relevant strategies to address these problems, implemented the strategies, and assessed their outcomes. After a baseline survey of 4,692 births, 19,030 births were monitored from 2005-2008 to monitor neonatal and maternal mortality rates and maternal depression scores. Results show intention-to-treat estimates.