The groups of mothers are able to reduce neonatal mortality

Community groups of women have achieved a remarkable reduction in mortality rates in some of the poorest areas of India, according to a study published in the journal Lancet and presented by Dr. Anthony Costello in Congress on Labor Interatlântico and Primal Health Research, held in Las Palmas de Gran Canaria from 26 to February 28, 2012. In addition, support groups of mothers provided a significant reduction of maternal depression and improve women's ability to make decisions.

Each year about 4 million children die worldwide during the first month of life. Less than one quarter of the 68 countries that focused on the Millennium Development Goals of the UN (reducing child mortality below 5 years of age in two thirds by 2015) are on track to achieve that objective.

An earlier study conducted in Nepal and published in Lancet in 2004, noted that participatory groups of women could achieve a significant impact on neonatal health in the poorest countries, much more than individual contact with a healthcare professional. In this project, found a reduction of neonatal mortality of around one third.

To see if these findings could be applied to other countries, the researchers repeated the performance in Jharkhand and Orissa, two of the poorest states of India. Dying in these regions, respectively, 49 and 45 babies per 1000 live births, neonatal mortality rates well above the average in India, estimated at 39 per 1000 live births. As a basis for comparison, in Britain the rate is 4 per 1000 births.

Between 2005 and 2008, a team of researchers led by Professor Anthony Costello UK, Institute of Child Health, UCL (University College London) and Dr Prasanta Tripathy, Indian organization Volunteer Ekjut, assessed how they affected groups women to neonatal and maternal depression in areas where the intervention, compared to areas where these groups were promoted participatory.

In each group acted as facilitators recruited women in the area, respected in the community, not health professionals, usually married and with some schooling. The number of women who were part of the groups was increased from 1 in 6 women of reproductive age (17%) during the first year, more than half (55%) during the third year. In total, there were 19 030 births data for those three years.

The women worked through a "cycle of Community action in four steps, identify the problems associated with pregnancy, childbirth and newborn care, develop strategies to address these problems, such as improving health, raise funds and produce their own basic kits for delivery, working with local community leaders, teachers, politicians and others to implement these strategies, and evaluate the success of these interventions.

"It was crucial that women could think for themselves on the problems and develop their own coping strategies, rather than tell them what to do," said Dr. Nirmala Nair Ekjut organization. "We think a trained facilitator who supports peer learning is more effective in achieving lasting change in behavior that the traditional approach based on an instructor who teaches you have to learn."

The effect of the interventions was spectacular in the second and third years of the trial, in areas where women's groups pushed neonatal mortality was reduced by 45%. In these areas also significantly reduced maternal depression, 57%.

"We saw a change in behavior: improved hygiene practices, and better care for newborns," said Professor Costello. "It went from harmful practices such as giving birth in dirty places or delay the onset of lactation, to significantly improve basic hygiene by those attending the birth, the umbilical cord is cut and the immediate response to the needs of mothers newborn care. "

The researchers believe that improving the social capital-access to the group provided women greater peer support network, was the most valuable aspect of the groups and contributed to the improvement of practices in the delivery and care babies, and in reducing maternal depression. This could also explain why these groups had much greater success than direct interventions by health professionals.

"Many women in these groups would be relatively young, with arranged marriages by their families, who live only with their mother or a very limited network of friends to provide support," said Audrey Prost, of the UCL. "The groups empower women to take preventive measures and can tackle problems more effectively when they arise. If you've been in a group and there is a problem, you have an instant support network to which you can go. "

Researchers estimate that the additional cost of supporting these groups for each life saved was about $ 910. However, there remains the question of who would pay to support such groups, both the Governor and federal government, nongovernmental organizations, or a combination of both.

The authors explain that "women's groups provided by other women reduced neonatal mortality and maternal depression moderate, low cost, largely tribal populations, rural, eastern India. The most likely mechanism of mortality reduction is the improvement of hygiene and care practices. " Furthermore, "equity groups had the advantage of helping the poorest, can be applied on a larger scale, have a low cost and produce powerful lasting effects. By focusing toward critical consciousness, the groups have the ability to improve the skills of the community to address the difficulties related to health and development, stemming from poverty and social inequalities. "

The journal Lancet published a second study conducted by the same team, also on formation of women's groups, but this time in Bangladesh. In this country, there were no such dramatic results as in India. However, in this case, the researchers believe a number of issues influenced the results: the impossibility of obtaining an adequate network of women's groups, as in India, or the recruitment of pregnant women in the study conducted in the India.