Abstract
BackgroundA randomised controlled trial of participatory women's groups in rural Nepal previously showed reductions in maternal and newborn mortality. In addition to the outcome data we also collected previously unreported information from the subgroup of women who had been pregnant prior to study commencement and conceived during the trial period. To determine the mechanisms via which the intervention worked we here examine the changes in perinatal care of these women. In particular we use the information to study factors affecting positive behaviour change in pregnancy, childbirth and newborn care.MethodsWomen's groups focusing on perinatal care were introduced into 12 of 24 study clusters (average cluster population 7000). A total of 5400 women of reproductive age enrolled in the trial had previously been pregnant and conceived during the trial period.For each of four outcomes (attendance at antenatal care; use of a boiled blade to cut the cord; appropriate dressing of the cord; not discarding colostrum) each of these women was classified as BETTER, GOOD, BAD or WORSE to describe whether and how she changed her pre-trial practice. Multilevel multinomial models were used to identify women most responsive to intervention.ResultsAmong those not initially following good practice, women in intervention areas were significantly more likely to do so later for all four outcomes (OR 1.92 to 3.13). Within intervention clusters, women who attended groups were more likely to show a positive change than non-group members with regard to antenatal care utilisation and not discarding colostrum, but non-group members also benefited.ConclusionWomen's groups promoted significant behaviour change for perinatal care amongst women not previously following good practice. Positive changes attributable to intervention were not restricted to specific demographic subgroups.
Highlights
A randomised controlled trial of participatory women's groups in rural Nepal previously showed reductions in maternal and newborn mortality
Most births and newborn deaths occur outside health facilities, so behaviour change in relation to home care practices and care-seeking behaviour is an essential component of any strategy to reduce deaths
For all four practices women who were initially following bad practice were significantly more likely to change to good practice if they lived in an intervention village development committee areas (VDCs) (BETTER/BAD ratios)
Summary
A randomised controlled trial of participatory women's groups in rural Nepal previously showed reductions in maternal and newborn mortality. In addition to the outcome data we collected previously unreported information from the subgroup of women who had been pregnant prior to study commencement and conceived during the trial period. To determine the mechanisms via which the intervention worked we here examine the changes in perinatal care of these women. We reported previously a cluster randomised controlled trial of the effects of participatory women's groups on neonatal outcomes in rural Nepal[1]. The trial intervention was a woman facilitator (who was not a trained health worker) within each area paid to instigate and guide women's groups focused on care in the perinatal period. The trial showed significant falls in neonatal (30%) and maternal mortality (78%), and appeared to be cost effective[2].
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