Community members are not only intervention recipients; they are powerful tools for change

Written by Lorna Benton, PhD candidate at the UCL Institute for Global Health.

A recent Lancet meta-analysis (http://bit.ly/10Jz9Gc) demonstrated the success of women’s group interventions in significantly reducing maternal and new-born mortality rates.

Following on from this, the Institute for Global Health and the Grand Challenge for Global Health hosted a joint symposium with the London School of Hygiene and Tropical Medicine, entitled ‘Community based new-born and maternal care’, to ask how such community based women’s groups could be used to deliver life-saving information and support globally.

Participatory learning and action can save lives

Dr David Osrin of IGH first highlighted the inequity of maternal and new-born deaths, showing that a staggering 65% of deaths occur in just ten countries across the world.

Discussions then turned to how learning through discussions within women’s groups could be used as a successful strategy to improve community based new-born and maternal care – an approach that has not yet been delivered at scale.

Dr Osrin reported that these women’s groups led to a 37% reduction in maternal mortality and a 23% reduction in new-born mortality, Dr Osrin then pondered the most important question: how did this work?

Connections matter to people

The panel discussions emphasised a need to break down the complex puzzle into pieces and to focus on simple preventative interventions rather than complex treatments, with communication-centred approaches as the cornerstone to success.

Osrin explained that women’s groups worked using an ‘action cycle’ that allowed women to select topics relevant to them which were then discussed and for which solutions were then found as a community.

The simple act of discussion helped to share knowledge and resulted, for example, in improved sanitary conditions during home delivery by birth attendants and further supported women to adopt earlier infant feeding practices.

Crucially, the meta-analysis of interventions found that various approaches to this learning-style led to a significant reduction in mortality, when attendance of women of childbearing age in the area was greater than 30%.

Scaling up… we need to look for the synergies

Looking to understand what this could mean for the future of maternal and neonatal practices in remaining grand round countries, Professor Joy Lawn discussed how to translate evidence to action and stated that a personal goal of hers was to improve outcomes for every woman and baby – even the poorest.

Professor Lawn felt it was a common fallacy that community empowerment should mean all births are delivered at home and that sub-national data demonstrated that countries had perhaps been more sensible in their implementation of home-based care interventions.

Traditional birth attendants often still encouraged delivery in a medical facility and a first postnatal visit within 24 hours of delivery, but reported that postnatal visits were unlikely without a pregnancy visit and that many women remain in need of support.

The audience was reminded that although home visits by traditional birth attendants had significantly reduced neonatal mortality within study settings, this impact was not always translated to larger settings.

The main barrier to success is the shortage of skilled midwives in many countries, which makes monitoring new mothers difficult.

Both the audience and the panel agreed that recruitment and training were, therefore, key priorities, and that incentivisation of community health workers was also needed to improve retention.