Support Groups Improve Birth Outcomes

(Ivanhoe Newswire) -- Community support groups may be able to reduce neonatal deaths and lower rates of maternal depression, but only if the population coverage is wide enough and the programs are appropriately designed.

In trials in Nepal, participatory women's groups reduced neonatal mortality by about one-third. To test this approach further, two research teams undertook randomized controlled trials led by Anthony Costello of University College London, Centre for International Health and Development, Institute of Child Health in London.

Prasanta Tripathy of Ekjut in Chakradharpur, Jharkand, India, and colleagues assigned a population of 228,186 people in Jharkand and Orissa in eastern India either to participate in women's groups focused on the reduction of maternal and newborn health problems, or not. The researchers monitored 19,030 births over three years and found that neonatal mortality dropped by 32 percent overall, and by 45 percent in years two and three, for women who had been living in areas where support groups existed. Moderate maternal depression had fallen by 57 percent by the third year.

The authors were quoted as saying, "Women's groups led by peer facilitators reduced neonatal mortality rates and moderate maternal depression at low cost in largely tribal, rural populations of eastern India. The most likely mechanism of mortality reduction was through improved hygiene and care practices."

"Participatory groups have the advantage of helping the poorest, being scalable at low cost, and producing potentially wide-ranging and long-lasting effects,” they concluded. “By addressing critical consciousness, groups have the potential to create improved capability in communities to deal with the health and development difficulties arising from poverty and social inequalities."

In an accompanying article, Professor Kishwar Azad of the Perinatal Care Project, Diabetic Association of Bangladesh, and colleagues monitored neonatal mortality for 36,113 births over three years in a population of 503,163. The study population was divided into clusters, some of which were assigned to receive support from women's groups. The authors found that in Bangladesh, the community support made no difference to neonatal mortality rates.

They were quoted as saying, "For participatory women's groups to have a significant effect on neonatal mortality in rural Bangladesh, detailed attention to program design and contextual factors, enhanced population coverage, and increased enrolment of newly pregnant women might be needed."

They added, "Women's groups, if scaled to an adequate coverage, have the potential to reach the poorest people and bring about substantial health and non-health benefits. Nonetheless, a women's group approach requires adequate human resources support for community mobilization and appropriate coverage."

SOURCE: The Lancet, published online March 7, 2010

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