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Participatory Women’s Groups

Community-led, Evidence-based Action from Bangladesh, India, Malawi and Nepal: Improving Maternal and Newborn Survival



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New: Good Practice Guide 2013 [PDF]: Community mobilisation through Women's Groups to help improve the health of mothers and babies

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THE PROBLEM

  • Around 270,000 women worldwide die every year from complications of pregnancy and childbirth, and nearly three million infants do not survive the first month of life.
  • In sub-Saharan Africa, South Asia, and Southeast Asia, more than 70% of all births for the poorest two fifths of women happen at home.
  • Community interventions are needed to increase demand for health services and protective practices for mothers and newborns at home.

THE SOLUTION

Community-based interventions are crucial to reduce the shocking toll of unnecessary and preventable deaths of mothers and babies. One approach involves women’s groups meeting regularly to identify and prioritise problems during pregnancy, delivery and the postnatal period. Groups develop and implement strategies through participatory methods such as voting, role-play, storytelling and problem-solving. The groups boost women’s confidence to talk about the problems they face, take live-saving steps, and influence community members beyond the group.

"It's not a drug. It's not a vaccine. It's not a device. It's women, working together, solving problems, saving lives." says Richard Horton, Lancet Editor.

The reasons why mothers and newborns die are social as much as medical. Many life-saving preventive practices can be also performed at home if mothers know how and have the self-assurance to act. When women’s groups sit together and discuss why health problems happen from a social perspective, they find locally appropriate ways to address their problems. 

THE RESULTS

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The paper published in the Lancet was launched at an event at the Houses of Parliament on the 21st May.

''Maternal deaths fell by 37% and newborn deaths by 23%''

A UCL analysis of seven trials conducted in Bangladesh, India, Nepal and Malawi, with a total of 119,428 births found that women’s groups can dramatically reduce maternal and newborn deaths in the poorest communities. In all seven studies, a local woman helped to facilitate women’s groups which identified and addressed common health problems in pregnancy, and during and after birth.

The findings from the seven studies showed that maternal deaths fell by 37% and newborn deaths by 23%; but they fell by as much as 55% for maternal deaths and 33% for newborn deaths in the four studies where more than a third of pregnant women participated in the groups.

The groups could prevent an estimated 283,000 newborn infant deaths and 41,100 maternal deaths each year if they were introduced in 74 countries where maternal and child death rates remain high.

Women Deliver 2013

On 28 May 2013  Institute for Global HealthWomen and Children First joined with from Bangladesh, India, Malawi, Nepal and UCL’s  to present the latest findings from over a decade of women’s group work at the third Women Deliver conference in Kuala Lumpur, Malaysia.

The side event, Women’s Groups Help Improve Maternal, Newborn and Child Health: Community-led, Evidence-based Action from Bangladesh, India, Malawi and Nepal, included presentations from Prof Dharma Manandhar (MIRA, Nepal), Prof Kishwar Azad (Perinatal Care Project, Bangladesh), Dr Nirmala Nair (Ekjut, India), Florida Banda (MaiMwana, Malawi) and Prof Anthony Costello  (UCL Institute for Global Health).

The impressive results of the women’s groups work include:

Nepal – 30% reduction in newborn deaths and substantial decreases in maternal mortality. Click here for the presentation and below for the publication:

Manandhar et al (2004), Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial

India – 45% reduction in newborn deaths and moderate maternal depression fell by 57%. Click here for the presentation and below for the publications:

Tripathy et al (2010), 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

Rath et al (2010), Explaining the impact of a women’s group led community mobilisation intervention on maternal and newborn health outcomes: the Ekjut trial process evaluation

Nair et al (2010), Improving Newborn Survival in Low-Income Countries: Community-Based Approaches and Lessons from South Asia

Houweling et al (2013),The equity impact of participatory women’s groups to reduce neonatal mortality in India: secondary analysis of a cluster-randomised trial

Bangladesh – 38% reduction in newborn deaths. Click here for the presentation and below for the publications:

Azad et al (2010), Effect of scaling up women’s groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial

Nahar et al (2012), Scaling up community mobilisation through women’s groups for maternal and neonatal health: experiences from rural Bangladesh

Fottrell et al (2013), The Effect of Increased Coverage of Participatory Women’s Groups on Neonatal Mortality in Bangladesh

Malawi – 74% reduction in maternal deaths and 41% reduction in newborn deaths. Click here for the presentation and below for the publications:

Rosato et al (2010), MaiMwana women’s groups: a community mobilisation intervention to improve mother and child health and reduce mortality in rural Malawi

Lewycka et al (2013), A cluster randomised controlled trial of the community effectiveness of two interventions in rural Malawi to improve health care and to reduce maternal, newborn and infant mortality

The results of a meta-analysis including seven randomised controlled trials demonstrates a reduction in maternal deaths of up to 55% (where at least 30% of pregnant women took part in the groups) and newborn deaths reduced by a third.

Prost et al (2013), Women’s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis

You can find other relevant women’s groups resources including a women’s groups summary, Good Practice Guide, women's group facilitation manuals, picture cards and flipcharts.