Improving Maternal and Newborn Health Through Participatory Learning and Action Facilitated through Accredited Social Health Activists in Eastern India: A Cluster Randomized Controlled Trial

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: A quarter of the world’s neonatal deaths and 17% of maternal deaths occur in India. Few community-based interventions to improve maternal and newborn health have been tested through the community health workers supported by India’s National Rural Health Mission (NRHM).

Methods: We did a cluster-randomized controlled trial of a community intervention to improve maternal and newborn heath in 30 geographic clusters in five rural districts of Jharkhand and Odisha, eastern India, covering a population of 156,518. Government approved Accredited Social Health Activists (ASHAs) supported women’s group through a participatory learning and action cycle. The groups discussed and prioritized maternal and newborn health problems, prioritized and implemented feasible strategies to address them, then evaluated their progress. The trial’s primary outcome was neonatal mortality. Secondary outcomes included preventive and care-seeking practices. Fifteen clusters were allocated to the intervention group and another fifteen to control. In each cluster, around 10 ASHAs performed their government-mandated activities and facilitated women’s group meetings. In control areas, ASHAs only performed their usual activities. Study participants were women (15-49) who gave birth between 1st September 2009 and 31st December 2012 in the 30 clusters. We identified births, stillbirths, and neonatal deaths, and interviewed mothers six weeks after delivery.

Results: Analysis of 7219 births over two years showed a 31% reduction of neonatal mortality in intervention areas compared to control areas (Odds Ratio: 0.69, 95% CI: 0.53-0.89). The decline was greater (46%) when adjusted for baseline differences in mortality (aOdds Ratio: 0.54, 95% CI: 0.37-0.81). There were increases in the proportion of infants wrapped and placed on their mother’s skin within one hour of birth, and non-significant improvements in birth preparedness and health facility births.

Conclusion: Women’s group meetings facilitated by ASHAs reduced neonatal mortality. Scaling up this strategy may be feasible in rural underserved areas of India.