ehaviour change in perinatal care practices among rural women exposed to a women's group intervention in Nepal
Background: A randomized, controlled trial of participatory women's groups in rural Nepal previously showed reductions in maternal and neonatal mortality. In addition to the outcome data, we also collected previously unreported information from the subgroup of women who had been pregnant prior to study commencement and conceived during the trial period. To determine the mechanisms by which the intervention worked, we examined the changes in perinatal care of these women. In particular, we used the information to study factors affecting positive behaviour change in pregnancy, childbirth, and newborn care.
Methods: Women's groups focusing on perinatal care were introduced into 12 of 24 study clusters (average cluster population, 7000). A total of 5400 women of reproductive age enrolled in the trial had previously been pregnant and conceived during the trial period [date not given]. For each of the 4 outcomes (attendance at antenatal care; use of a boiled blade to cut the cord; appropriate dressing of the cord; and not discarding colostrum), each woman was classified as better, good, bad or worse to describe whether and how she changed her pre-trial practice. Multilevel multinomial models were used to identify women most responsive to intervention.
Results: Among those not initially following good practice, women in intervention areas were significantly more likely to do so later for all 4 outcomes (OR, 1.92-3.13). Within intervention clusters, women who attended groups were more likely to show a positive change than non-group members with regard to antenatal care utilization and not discarding colostrum, but non-group members also benefited.
Conclusion: Women's groups promoted significant behaviour change for perinatal care among women not previously following good practice. Positive changes attributable to intervention were not restricted to specific demographic subgroups.