The involvement of trained women in healthcare in Jharkhand and Orissa has helped reduce neo-natal mortality by 45% and moderate postpartum depression by 57%, says a new study
A three-year programme by a team of researchers from the Institute of Child Health, University College London, and the Indian voluntary organisation Ekjut, has proved that participatory women’s groups could have a dramatic effect on improving the health of women and children.
Between 2005 and 2008, the team trained ordinary village women in Chakradarpur, in Jharkhand’s West Singbhum district, and in Orissa in the basics of health and nutrition. Neo-natal mortality rates in the two regions are 49 and 45 per 1,000 live births respectively, disproportionately higher than India’s national average of 39 per 1,000.
Starting with 20 women in three villages, six years ago, today there are 20,000 trained women spread across 1,000 villages in nine districts of Jharkhand and Orissa.
The women are trained to encourage adolescent girls and women to find “practical solutions for good health during the pre- and post-pregnancy period,” says group coordinator Sumitra Gagrai. Village women selected as ‘facilitators’ talked to women mostly in self-help groups about the merits of breastfeeding, wrapping newborns snugly, and boiling blades to cut the placenta.
“We first ask the self-help groups whether we can join them, then begin by telling stories -- real stories -- about how someone lost a baby,” explains Gagrai. “After that, we ask them to think about what might have gone wrong.”
The women worked through a ‘community action cycle’ involving four stages: identifying the problems associated with pregnancy, childbirth and care of newborns; developing strategies to tackle these problems, such as improving hygiene, raising emergency funds and producing their own birthing kits; working with local community leaders, teachers, politicians and others to implement these strategies.
The results of the study, published in the prestigious medical journal The Lancet, showed a 45% reduction in neo-natal mortality, a 57% reduction in moderate postpartum depression and a more healthy approach towards child-rearing in the area.
“What we were seeing was a change in behaviour towards better hygiene practices and improved care for newborns,” says Professor Costello, who led the UCL team. “There was a move away from harmful practices such as giving birth in unclean environments and delaying breastfeeding. We saw significant improvements in areas such as basic hygiene by birth attendants, clean cord care, and women responding earlier to care needs.”
It was not easy to convince villagers that their womenfolk should participate in the project. Thirty-three-year-old Kulsim Sondhi recalls that the gram pradhan in her village opposed women who wanted to assist her during her pregnancy, on grounds that they were carrying pictures of semi-naked women which would destroy the village’s culture!
Training village women to look after the health of their communities is not a new concept and it has worked extraordinarily well in most places where it has been tried out.
‘This intervention could be used with or as a potential alternative to health-worker-led interventions, and presents new opportunities for policymakers to improve maternal and newborn health outcomes in poor populations,’ The Lancet concludes.
Source: www.thelancet.com, April 3, 2010
Press release of the Wellcome Trust, March 8, 2010
The Telegraph, March 8, 2010