Supporting Safe Motherhood Services In Diyarbakir: A Community-Based Distribution Project

Abstract

To provide pregnant and puerperal women experiencing problems with receiving health care in Diyarbakir, Turkey, with an education program and counseling to help them attain appropriate health behaviors and to support receiving health care through a community based distribution model. This article is a descriptive report of a qualitative community based distribution project conducted in cooperation with the Women's Research and Implementation Centre (WRIC) of Diyarbakir Metropolitan Municipality (DMM) and Turkish Family Health and Planning Foundation. The study was carried out between March 2007 and April 2008 in six districts of Diyarbakir, a region with a population of 37,000 people of low socio-economic status and who immigrated from the surrounding villages. A total of 6,029 families were visited and 1,119 pregnant and puerperal women were contacted, provided with education and counseling and referred to primary health care clinics at home visits. Seven women living in the region were selected and educated so that they could offer peer education and educational material was prepared for the target group. The pregnant and puerperal women living in the study area were recorded and referred to primary health care clinics. They were visited four times during pregnancy and three times during puerperium and were provided an education program and counseling. Data were collected from the records made during monitoring the women and focus group discussions with women, peer trainers and health care staff. They were found to acquire appropriate health behaviors, 36.2 % women started to receive health care from primary health care clinics for the first time and 86.9 % of the deliveries were performed at health centers. The pregnant and puerperal women were satisfied with home visits, felt special and put the information about self-care into practice. The number of the women receiving iron supplements and vaccine against tetanus and receiving regular care increased.

Health education strategies targeting maternal and child health

“…Community-based strategies were reported by Jones and Mondy, [10] Turan and Say, [11] MacArthur et al, [12] Brasington et al, [13] Barnet et al, [14] Coskun and Karakaya [15] and Little et al [16] Although we found this methodology to be the most frequently implemented strategy, some outcomes—such as breastfeeding—showed no evidence of improvement with this approach. [35] However, this observation should not discourage policy makers from using community-based methodologies, as more studies and systematic reviews are necessary to draw firm conclusions about the effectiveness of this strategy.…”

“…Seventeen out of the 23 studies were conducted in high-income countries. [10,12,14,16,17,19,20–25,27–29,31,32] The only 6 studies that were not from high-income countries were carried out on mothers from Brazil [26] (upper-middle income), Turkey [11,15,30] (upper-middle income), Egypt [13] (lower-middle income) and Iran [18] (upper-middle income).…”

“…Education activities that start during the antenatal period and continue postpartum appeared to be more effective than methods which focused on education during pregnancy only. [3] This review highlighted that educational activities which continued after birth [14,15,21] were associated with better outcomes in terms of breastfeeding continuation at 6 months, appropriate health behaviors, improved knowledge of health care and school continuation. Only 1 included article did not report improved outcomes with the continuation of health education activities into postpartum.…”

“…The systematic reviews published by McFadden et al, [34] Balogun et al [35] and Silva et al [3] did not find that health education programs developed to be delivered by either healthcare professionals or healthcare non-professionals differed in their impact on breastfeeding or obstetric outcomes. In the present review, the reports of Jones and Mondy, [10] Turan and Say, [11] MacArthur et al, [12] Brasington et al, [13] Barnet et al, [14] Coskun and Karakaya, [15] Little et al, [16] Adams et al [25] and Guo et al [31] used non-professionals to promote health education, and the majority observed good outcomes, reinforcing the importance of including community members or peers in educational processes.…”