Understanding the mechanisms through which women's group community participatory intervention improved maternal health outcomes in rural Malawi: was the use of contraceptives the pathway?

Collins O F Zamawe,Chrispin Mandiwa

doi:10.3402/gha.v9.30496

Collins O F Zamawe, Chrispin Mandiwa

Open Access

https://doi.org/10.3402/gha.v9.30496

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Abstract

BackgroundWomen's group intervention is a community based initiative through which rural women form groups, meet regularly to discuss maternal health issues affecting them, and come up with locally available solutions. This intervention has been associated with reduced maternal and neonatal mortality in limited resource settings. Nevertheless, the mechanisms through which women's groups influence maternal health outcomes are uncertain. Because contraception reduces the risk of maternal mortality and women's groups also tackled this issue, we speculated that contraceptive use might be the pathway. Consequently, this study investigated whether participation in women's groups was associated with contraceptive use in Malawi.DesignWe examined the use of contraceptives between women who participated in women's groups and those who did not through a community-based cross-sectional study in Mchinji, Malawi. The study involved 3,435 women of reproductive age (15–49 years) who were recruited using a multistage sampling approach. Members (treated) and non-members (control) of women's groups were matched on observed covariates using propensity scores and the counterfactual for the treated individuals was estimated.ResultsCrude analysis revealed that women's groups improved uptake of contraceptives by 26% (odds ratio (OR)=1.26; 95% confidence interval (CI)=1.03–1.56; p=0.024). However, using the matched data, uptake of contraceptives was almost the same among members and non-members of women's groups. More precisely, the likelihood of using contraceptives was not significantly different between the members and non-members of women's groups (OR=1.00; 95% CI=0.81–1.24; p=0.991).ConclusionsThere is insufficient evidence of an association between participation in women's groups and contraceptive use among rural Malawian women. The implication is that contraception was not the mechanism through which women's groups contributed to reduced maternal mortality in Malawi. Because the effects of community interventions are usually comprehensive and sometimes difficult to demonstrate, ethnographic studies should be considered in the evaluation of women's groups and other related interventions.

Highlights

Even though the maternal mortality ratio (MMR) has gone down by about 45% worldwide since 1990, many women continue to die each year due to preventable pregnancy-related complications [1]. Most of these deaths occur in low- and middle-income countries (LMICs) [1]
Of the 3,435 respondents who were included in the analysis, 1,098 (32.0%) participated in the women’s groups
More decisions regarding contraception were made by women (57.3%) than men (42.7%), though this was not significantly associated with the use of contraceptives (p00.554)

Summary

Introduction

Even though the maternal mortality ratio (MMR) has gone down by about 45% worldwide since 1990, many women continue to die each year due to preventable pregnancy-related complications [1]. Most of these deaths occur in low- and middle-income countries (LMICs) [1]. Women’s group intervention is a community based initiative through which rural women form groups, meet regularly to discuss maternal health issues affecting them, and come up with locally available solutions This intervention has been associated with reduced maternal and neonatal mortality in limited resource settings. Because the effects of community interventions are usually comprehensive and sometimes difficult to demonstrate, ethnographic studies should be considered in the evaluation of women’s groups and other related interventions

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