Understanding how women's groups improve maternal and newborn health in Makwanpur, Nepal: a qualitative study

Abstract

Women's groups, working through participatory learning and action, can improve maternal and newborn survival. We describe how they stimulated change in rural Nepal and the factors influencing their effectiveness. We collected data from 19 women's group members, 2 group facilitators, 16 health volunteers, 2 community leaders, 21 local men, and 23 women not attending the women's groups, through semi-structured interviews, group interviews, focus group discussions and unstructured observation of groups. Participants took photographs of their locality for discussion in focus groups using photoelicitation methods. Framework analysis procedures were used, and data fed back to respondents. When group members were compared with 11 184 women who had recently delivered, we found that they were of similar socioeconomic status, despite the context of poverty, and caste inequalities. Four mechanisms explain the women's group impact on health outcomes: the groups learned about health, developed confidence, disseminated information in their communities, and built community capacity to take action. Women's groups enable the development of a broader understanding of health problems, and build community capacity to bring health and development benefit.

Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

“…However, several articles were exceptions to this overall pattern as they related to specific health conditions but also disseminated information supporting broader community participation. These included articles focusing on mental health [33], onchocerciasis control [24, 34, 35], participatory learning and action cycles through women’s groups in India and Nepal to improve maternal and newborn health [19, 20, 36], and efforts by community-based organizations in India to support to HIV-positive individuals to access government entitlement programs [37]. …”

“…Examples of broad participation include those that engaged community members irrespective of their caste, gender or socio-economic differences, such as women from diverse backgrounds and various ethnic groups [19, 41, 42, 45, 56] or committees with representatives from different community based organizations and vulnerable groups [23, 33]. Some examples also detailed how initiatives spread beyond their intended target group, for example women’s groups in Malawi later formally included men [19, 20, 43, 61].…”

“…Some examples also detailed how initiatives spread beyond their intended target group, for example women’s groups in Malawi later formally included men [19, 20, 43, 61]. …”

“…Some articles explicitly state that group meetings or classes were open to all, with no restriction on type of participants, and interventions took specific measures to ensure inclusion, such as offering scholarships to remove financial barriers to enrolment [22] or by not selectively mobilizing the elite or better-off groups [19, 22]. An intervention propagating a supervisory model for local health facilities restricted involvement to community leaders, but ensured representation from teachers, village headman, representatives from sub-district administration office, group of elders, housewives, village health volunteer groups and village development committee as leaders [38].…”

Postpartum Hemorrhage; a Major Killer of Woman: Review of Current Scenario

“…Hence, by bringing behavioral changes at individual and family levels, one can facilitate women's and their families' health, awareness of potential obstetric and neonatal risk, increasing their knowledge of good pregnancy and delivery care, equipping them with skills to take health-enhancing decisions, and building self-efficacy for requesting assistance from other community members or local health authorities [71]. Diffusion of new knowledge and awareness can be facilitated by media messages, outreach workers, or community members themselves.…”