Abstract
BackgroundPakistan has high maternal mortality, particularly in the rural areas. The delay in decision making to seek medical care during obstetric emergencies remains a significant factor in maternal mortality.MethodsWe present results from an experimental study in rural Pakistan. Village clusters were randomly assigned to intervention and control arms (16 clusters each). In the intervention clusters, women were provided information on safe motherhood through pictorial booklets and audiocassettes; traditional birth attendants were trained in clean delivery and recognition of obstetric and newborn complications; and emergency transportation systems were set up. In eight of the 16 intervention clusters, husbands also received specially designed education materials on safe motherhood and family planning. Pre- and post-intervention surveys on selected maternal and neonatal health indicators were conducted in all 32 clusters. A district-wide survey was conducted two years after project completion to measure any residual impact of the interventions.ResultsPregnant women in intervention clusters received prenatal care and prophylactic iron therapy more frequently than pregnant women in control clusters. Providing safe motherhood education to husbands resulted in further improvement of some indicators. There was a small but significant increase in percent of hospital deliveries but no impact on the use of skilled birth attendants. Perinatal mortality reduced significantly in clusters where only wives received information and education in safe motherhood. The survey to assess residual impact showed similar results.ConclusionsWe conclude that providing safe motherhood education increased the probability of pregnant women having prenatal care and utilization of health services for obstetric complications.
Highlights
Pakistan has high maternal mortality, in the rural areas
The community-based interventions (CBI) package had an impact on utilization of health services for prenatal care and during obstetric complications
The CBI package included training of traditional birth attendants (Dais), it is not possible to segregate the impact of the training from that of the information and education for empowerment and change (IEEC) strategy
Summary
Pakistan has high maternal mortality, in the rural areas. The delay in decision making to seek medical care during obstetric emergencies remains a significant factor in maternal mortality. Causes of the second delay (lack of access to transport and telecommunication, unfamiliarity with the health system, and financial and social barriers) can be addressed through community mobilization programs. Both of these delays could be reduced through community-based interventions (CBI) involving women and their husbands, the birth attendants and the community leaders. Regardless of these considerations, country-level evidence accumulated over the last two decades suggests that a reduction in maternal mortality can only be brought about by providing skilled birth attendance and access to emergency obstetric care. We evaluate the impact of including husbands in the behaviour change communication programs for safe motherhood
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