Women's Group Intervention Is Tied to Lower Neonatal Mortality In Rural Communities in India

Abstract

An intervention involving participatory women's groups facilitated by government-approved social workers was associated with reduced neonatal mortality in rural communities in eastern India, according to a cluster-randomized controlled trial conducted between 2009 and 2012. (1) Compared with births to women living in control communities, those to women living in intervention communities had 31% lower odds of resulting in death of the infant within the first 28 days of life (odds ratio, 0.7). In addition, the odds of certain home care practices--e.g., birth attendant's using a safe delivery kit and placing the infant against the mother's skin within one hour of birth--were greater for births occurring in intervention communities than for those in control communities (odds ratios, 1.4-5.1). For the study, researchers chose 30 clusters--geographic areas with a population of about 5,000 individuals each--from five rural districts of the Jharkhand and Odisha states of eastern India. Half the clusters were randomly selected to receive an intervention, which was implemented in September 2010 and consisted of a series of women's group meetings led by village-based accredited social health activists (ASHAs)--female community health workers trained under India's National Rural Health Mission. ASHAs purposively invited pregnant women and new mothers to participate; however, the meetings were open to all local women. During meetings, women discussed maternal and newborn health problems, strategized about how to solve them, implemented the strategies and assessed their progress. Control clusters did not receive the group meeting intervention; however, in all clusters, the researchers met with village health sanitation and nutrition staff, and with government officials and hospital management to address issues relevant to maternal and newborn health. Data were collected for a baseline period consisting of the year before the intervention was implemented and for a two-year evaluation period beginning three months after implementation. Monitoring teams attempted to ascertain all births and deaths to women of reproductive age living in study clusters through reports from local key informants and through birth records. Researchers interviewed mothers about six weeks after a delivery to document pregnancy- and birth-related events and practices, and conducted verbal autopsies for deaths among infants and mothers. One intervention cluster was lost to follow-up and was dropped from analyses. Descriptive analyses were used to compare baseline characteristics across groups, and logistic regression analyses were conducted to assess whether the intervention was associated with various outcomes, primarily neonatal mortality (i.e., death of an infant in the first 28 days of life), as well as home care and care-seeking practices. During the baseline period, 3,244 women (1,635 from intervention clusters and 1,609 controls) experienced 3,304 births. Overall, the mean age of mothers was 24.7 years; 65% could not read, and 58% had not attended school. The socioeconomic characteristics of women were the same across groups, except a greater proportion of women in the control group than of those in the intervention group had a secondary or higher education (33% vs. …