Women’s Groups Practicing Participatory Learning and Action to Improve Maternal and Newborn Health in Low-Resource Settings

Abstract

Topic: Systems-based Practice M aternal and neonatal mortality rates remain high in many low-income and middle-income countries. To attain the Millennium Development Goals 4 and 5, different approaches to improve birth outcomes have been tried, including community-based interventions. Effects on survival have been heterogeneous and uncertain. This systematic review and meta-analysis of randomized controlled trials (RCTs) was done to assess the effects of women's groups practicing participatory learning and action on birth outcomes in low-resource settings.Seven databases and citations from reference lists were searched for RCTs carried out in Bangladesh, India, Malawi, and Nepal. Inclusion criteria for studies in the systematic review included: RCT, the intervention contained the stages of a participatory learning and action cycle, most participants were aged 15-49 years, and outcomes reported included maternal mortality, neonatal mortality, and stillbirths. The participatory learning and action cycle had 4 phases: (1) identify and prioritize problems during pregnancy, delivery, and postpartum; (2) plan;(3) implement locally feasible strategies to address the priority problems; and (4) assess the activities. Subgroup analyses were carried out to identify population-level predictors of effect. Incremental cost-effectiveness ratios were used for trials in which significant effects on the neonatal mortality rate were reported. Cost-effectiveness was expressed as the incremental cost per neonatal death averted and life-year saved.Seven RCTs performed between 1999 and 2011 that included a total of 119,428 births met the inclusion criteria. Group facilitators in the participatory programs were local women who were not health workers; they coordinated 9-13 group meetings per month after receiving 7-11 days of training in maternal and newborn health and participatory facilitation techniques. Exposure to women's groups was associated with 37% and 23% reductions in maternal and neonatal mortality, respectively. No association was found between participatory learning programs and a reduction in stillbirths. The proportion of pregnant women participating in the groups was linearly associated with reductions in both maternal and neonatal mortality, but no evidence of associations was found between the effects of the intervention and background mortality or institutional delivery rates. In studies in which Z30% of pregnant women participated in women's groups, a 55% reduction in maternal mortality and a 33% reduction in neonatal morality was observed. The women's participatory learning and action groups had strong effects on clean delivery practices for home deliveries and noticeable effects on breastfeeding. Women's groups were a highly cost-effective intervention as determined by World Health Organization standards. The intervention could save an estimated 283,000 newborns and 41,100 mothers per year if implemented in rural areas of 74 countdown countries (those countries targeted for attaining Millennium Goals by 2015).Wome...

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