Abstract
BackgroundMaternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices.MethodsWe used cross-sectional data from a representative sample of 4684 women with children aged 0–11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding.ResultsAbout 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p < 0.05).ConclusionWe found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.
Highlights
Maternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa
In the majority of cases the husband (80%) participated in the Family Conversation followed by the woman’s mother (27%), mother-in-law (19%), neighbor (16%), and sister (7%), as well as other people. Of those who reported having had Family Conversation, more than two-thirds were conducted by Health Extension Worker (HEW), with and without Women’s Development Army (WDA) members, and about a quarter of the sessions were conducted by WDA members only
Women who were more literate, who were older, those who were living in a higher Community-Based Data for Decision-Making (CBDDM) score area, who were living in Tigray region, who followed Orthodox religion and those who had more antenatal visits, were more likely to report that they had had a Family Conversation
Summary
Maternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. Ensuring childbirth takes place at institutions with emergency obstetric and newborn care services, as well as postnatal follow-up of mother and newborn within 48 h of delivery, has been shown to reduce maternal and neonatal mortality [5,6,7,8]. Worldwide, both strategies have been adopted as mainstream approaches to reduce maternal and newborn deaths [9]
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