Rapid evidence summary: Community-based maternal and newborn health and self-care
Community-based interventions & self-care have the potential to significantly reduce adverse health outcomes in conflict-affected settings.
Co-authored with Katie Nilsen Johnson
Every year, an estimated 60 million women give birth outside health facilities, mainly at home, and 52 million births occur without a skilled birth attendant. Facility-based care is vital, but in the most vulnerable contexts, access to a facility is often not an option. The COVID-19 pandemic will further exacerbate the dangers women and babies face, as facilities become overstretched and as women decide not to seek formal health services due to increased exposure and risk. In our latest rapid evidence summary, we found that community-based interventions and self-care have the potential to significantly reduce adverse health outcomes in conflict-affected settings.
The literature strongly supports community-based interventions for improving maternal and neonatal health (MNH) in low-income and middle-income countries. We evaluated fourteen systematic reviews, two impact evaluations, and eleven other resources. Interventions ranged from facilitator-led women’s groups to community health worker (CHW) home visits for a range of MNH services, as well as community mobilization and referral to health services.
A common theme throughout the literature was that CHW interventions can be linked to a wide range of improvements for MNH, from improved uptake of tetanus immunization, usage of clean delivery kits for home births, institutional deliveries as well as early initiation of breastfeeding and health-care seeking behavior by mothers.
Key programs that stood out include the deployment of CHWs to identify pregnant women and link them to facility-based perinatal services through home visits in Neno District, Malawi. After switching from a patient-based to a household-based approach to care, a study of the Malawi program found significant increases in the uptake of antenatal and intrapartum care, however there was no significant change for postnatal care.
In Ethiopia, Senegal, and Kenya, integrating proven nutrition interventions into health programs at the community level improved access to and use of antenatal care, delivery services, and postnatal care, in particular improving use of iron-folic acid supplements during pregnancy. The impact evaluation noted that a key factor for success in improving MNH care by women in these cases was implementing contextually and culturally relevant behavior change communication strategies. For example, social mobilization, branding, and the use of promotional materials, dramas, scripts, and skits were linked to improving the likelihood of women seeking antenatal care.
Evidence suggests that alternative methods of community-based interventions, such as task-shifting, have the potential to improve MNH in underserved communities. In areas with limited resources, shortage of skilled birth attendants and lack of access to traditional healthcare facilities often result in increased risk of postpartum hemorrhage. Evidence also shows that task-shifting certain activities traditionally reserved for skilled birth attendants, such as uterotonic distribution and management of labor, to traditional midwives can result in the reduction of postpartum hemorrhage as well as higher utilization rates and satisfaction by mothers. Furthermore, the community-based distribution of certain medications, such as misoprostol for treatment of postpartum hemorrhage and antibiotics to reduce neonatal sepsis was also found to be effective. However, additional research in real-world resource-constrained settings is recommended.
Mobile and electronic reminders, peer-based programs, and women’s groups were also found to result in increased knowledge and action around maternal healthcare seeking behavior. However, significant barriers to implementation of community-based health care exist. Political opposition to relinquishing power to community-based workers is a recurrent theme through the history of CHW engagement, and lack of trust between community members and providers is still pervasive.
Overall, community-based interventions have been found to have a positive effect on maternal and neonatal health. Applied correctly, community-based MNH and self-care have the potential to improve health outcomes for pregnant women and newborns in hard-to-reach and underserved populations. We will continue to explore this path to equitable care throughout the maternal and neonatal care continuum.
Learn more about the interventions, results, and limitations in the full rapid summary.
See more evidence summaries on a variety of interventions in the link below
