Participatory Women's Groups Linked to Improved Neonatal Outcomes in India, But Not Bangladesh (Digests) (Report‪)‬

Women's groups that meet monthly to discuss, identify and address factors that contribute to poor maternal and neonatal health may improve birth outcomes in rural, low-resource settings--at least in some circumstances. A pair of randomized trials conducted in India and Bangladesh that examined the potential benefits of establishing such groups yielded mixed results. (1), (2) In the Indian study, the odds of neonatal mortality were lower in areas with participatory women's groups than in control areas without groups (odds ratio, 0.68), particularly during the final two years of the three-year study (0.55). No decrease in maternal depression--an outcome assessed only in the Indian trial--occurred for the study as a whole, although the odds of moderate depression were reduced in the women's group areas during the final year (0.43). In the Bangladeshi trial, however, no improvements in neonatal or maternal outcomes occurred in areas with women's groups, a finding that may reflect the lower density of groups in the Bangladeshi program. The trials were inspired by an earlier study in which a women's group intervention in rural Nepal produced neonatal mortality rates 30% lower than those in comparison areas. To examine whether this approach could be replicated in other low-resource settings, one follow-up trial was organized in three contiguous districts of Bangladesh (Bogra, Faridpur and Moulavibazar), and another in two Indian states (Jharkhand and Orissa). The trials, which were launched in 2005 and lasted about three years, were broadly similar in format. In each country, the study areas were divided into clusters, half of which were randomly chosen to serve as intervention areas. In Bangladesh, researchers met with leaders of 451 villages to obtain permission to establish women's groups in the intervention areas, and trained facilitators visited every 10th household to invite married women of reproductive age to join; in India, 172 existing women's groups (involved in savings and credit activities) were invited to participate in the intervention, and 72 additional groups were established. In both countries, groups met monthly and began by discussing the reasons for neonatal and maternal deaths and the problems that women face before, during and after delivery; at subsequent meetings, strategies for addressing these problems were discussed and, if possible, implemented. Groups used a variety of approaches, both in discussing problems (storytelling and role playing were frequently used) and in implementing solutions. Participatory group meetings were not held in the control clusters, although in these areas (as in the intervention areas) efforts were made to improve medical referral systems and to refresh providers' knowledge of neonatal and maternal care.