Lens on our lives: improving women’s health in Nepal

On 21 July, the UCL Centre for International Health & Development (CIHD) lunchtime seminar took an unusual form – a screening of a film made by a women’s group in rural Nepal which has been working to improve maternal and newborn health. Dr Jo Morrison has been exploring the use of participatory media in research and reports on how the film came about, and the issues it powerfully demonstrates.

Research in the rural states of Jarkhand and Orissa in India, and in Makwanpur District of Nepal, has shown 40% and 30% decreases in newborn mortality in areas where community women’s groups are active. These cluster randomised controlled trials were conducted in partnership with an Indian organisation, Ekjut, and in Nepal, with MIRA. They demonstrate that substantial improvements in maternal and newborn health can be made using a community based, participatory action approach to address problems and barriers to care-seeking using local resources (see Lancet research paper).

CIHD is also conducting research in Malawi and Bangladesh evaluating the impact of similar interventions. One group participating in the research received five days’ film-making training and have made a film about their experience. They interview local women who describe childbirth in rural Nepal, where 81% of women deliver at home, often without the assistance of a trained health worker. In a compelling interview, Satyadevi Golay describes what happened during her home delivery when her placenta did not deliver. Her mother in law stopped her from going to a health facility.

The film shows a nurse giving a tour of the facilities of the delivery room in the local Primary Heath Care Centre. She admits that she has never used some equipment, and she doesn’t know how it works. Group members show footage of a disused x-ray machine, and discuss the reasons why their local doctor is often absent.

Despite these cultural issues and health service weakness, the film demonstrates how the group is mobilising the community to deal with these issues. Group members explain how they gathered money in the night to rush a woman to hospital. They show their locally managed stretcher that enables community members to reach health services. Their community dramas and protests are captured on film, and their forceful suggestions to local women to use health facilities are undoubtedly effective!

The impact of women’s groups, like the one featured in this film, have been evaluated through a partnership between a Nepali organisation, MIRA, and the Centre for International Health and Development at the UCL Institute of Child Health. The women in this film are an example of women’s groups in other research sites – in India, Bangladesh, Nepal and Malawi – that have mobilised their communities to improve maternal and newborn survival.

Click on the player below to watch Nepal in the making.

If you are interested in finding out more about using participatory media in research and public engagement, a second film – Nepal in the making – introduces the research project and describes the process of training, researching, scripting and shooting of the film.

Group members are interviewed, and they describe their intimidation at the beginning of the process and their sense of achievement when they successfully learned new skills and completed filming. This film also includes interviews with myself and Mr Kirti man Tumbahangphe about the potential to use participatory media in research. Both films were funded by the Wellcome Trust.