Effect of participatory interventions with women’s groups on birth outcomes

Women's Group Makwanpur

Mother and Infant Research Activities (MIRA), Nepal

This programme comprises of evaluations of community-based participatory interventions with the aim of reducing maternal and neonatal mortality. The original study carried out in Makwanpur district, arose from the belief that communities themselves could be a route to improving health. Impressed by the findings of a study from Bolivia, which suggested that community-based women’s groups could develop strategies to increase the survival of their own children, we decided to test the idea in Nepal.

Makwanpur district is a poor, hilly, predominantly rural area in central Nepal with limited transport and health facilities. Working with Professor Dharma Manandhar and his team in MIRA, we strengthened district health services with training and equipment across the whole district, and then tested the community programme. To do this, we selected 24 areas in the district at random, matched them into 12 comparable pairs, ran our programme in one area from each pair and compared it with its partner.

The programme involved a local woman in each area, who worked with women’s groups to identify their major maternal and newborn problems and develop community-driven strategies to address them. When we compared the outcomes we saw a 30% fall in newborn deaths and an 80% fall in maternal deaths.

The extraordinary success of the programme has generated international discussion and set us on a path to refine, adapt and retest the model. We are now conducting cluster randomised controlled trials in five additional sites, each of which allows us to modify the model and adapt it for a different situation. Each site also allows us to measure a novel aspect of maternal and/or newborn health.