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22/05/2013 : Newborn deaths down by a third in Bangladesh

Women’s group community mobilisation, delivered at adequate population coverage, is a highly cost-effective approach to improve newborn survival and health behaviour indicators in rural Bangladesh, according to a paper published in this week’s JAMA Pediatrics.

The research, conducted by Women and Children First’s partners, the Perinatal Care Project at BADAS in Bangladesh and UCL’s Institute for Global Health was conducted to assess the effect of participatory women’s groups on birth outcomes in three rural districts of Bangladesh, where the vast majority of births take place at home.

Following on from one trial, published in 2010; which targeted just 3 per cent of pregnant women and had a low population coverage (one women’s group per 1,414 people) and very little impact on newborn deaths ; this second trial increased the number of women’s groups fivefold to test the impact of scaling up, actively engaging just over a third of pregnant women and increasing coverage to one women’s group per 309 people. Striking results were produced: a reduction in newborn mortality of up to 38 per cent.  It is likely that the substantial decrease in newborn deaths from infection and low birth weight was due to improved hygiene during home delivery, better newborn care and breastfeeding. Taken to scale, and, according to WHO criteria, the trial was “highly cost-effective”. This case study constitutes important learning on programme design, scale and cost-effectiveness: coverage matters.

Read the publication, The Effect of Increased Coverage of Participatory Women’s Groups on Neonatal Mortality in Bangladesh, in full.

17/05/2013 : New evidence to save mothers’ lives!

Findings from Women and Children First’s partners in Bangladesh, India, Malawi, and Nepal show that women's groups significantly reduce maternal deaths, as published in The Lancet today.

Clear and compelling evidence from Bangladesh, India, Malawi and Nepal shows that participatory women’s groups, which enable women to take control of their lives and mobilise the community, can have a significant impact on maternal and newborn survival in resource-limited, rural settings. Many simple but vital practices to improve hygiene, such as safe delivery kits and hand washing, can be performed at home if mothers have the knowledge and confidence to act. Benefits also include an increase in exclusive breastfeeding.

A recent meta-analysis which combines the results of seven randomised controlled trials – the gold standard for clinical studies – has yielded impressive results: women’s groups are associated with a 34 per cent reduction in maternal mortality and a 23 per cent reduction in newborn mortality. A further analysis of four of the studies, where at least 30 per cent of pregnant women took part in groups, indicates a 55 per cent reduction in maternal mortality and newborn deaths down by a third. Two factors appear to be crucial: coverage of one women’s group per 450-750 people and the participation of at least one third of pregnant women in the groups.

Participatory women’s groups have been shown to be highly cost-effective, according to World Bank criteria, and are potentially sustainable. With political will and financial investment, this proven approach could be scaled up to reach the poorest. Scaling up women’s groups could save the lives of an estimated 116,000 newborns and 9,370 mothers in India and 27,200 newborns and 5,980 mothers in Nigeria.

In spite of progress towards MDGs 4 and 5, the decline in newborn mortality remains slow and almost 800 women still die every day in pregnancy or childbirth. The majority of these preventable deaths occur in South Asia and sub-Saharan Africa. There is huge inequity within countries, with poor, marginalised women in rural settings far less likely than urban or wealthier women to receive skilled care during childbirth. In settings where most births take place at home, there is a strong rationale for community-based initiatives.

To read the article in full visit here

13/03/2013 : Join us in May at Women Deliver!

Women and Children First and partners from Bangladesh, India, Malawi and Nepal are joining together this May to present dramatic reductions in maternal and newborn death rates at the third global Women Deliver conference in Kuala Lumpur, Malaysia.

More than 5,000 participants from Ministries of Health, Finance and Development Cooperation, Parliaments, leading civil society organisations, global companies, media and more will convene from 28 to 30 May at the largest global meeting of the decade focusing on the health and well being of girls and women. Key note speakers include Melinda Gates, co-chair of the Bill & Melinda Gates Foundation, Michelle Bachelet, Executive Director, UN Women, and Babatunde Osotimehin, Executive Director, UNFPA.

Our session, titled, Women’s' Groups Help Improve Maternal, Newborn and Child Health: Community-led, Evidence-based Action from Bangladesh, India, Malawi and Nepal, will address how participatory learning and action through women's groups can dramatically reduce newborn deaths and catalyse improvements in the demand, delivery and quality of maternity services. Synthesizing evidence from several trials in Africa and Asia, this event asks how this proven intervention can be taken to scale.

Richard Horton (The Lancet) will moderate a panel discussion with Professor Anthony Costello (UCL’s Institute for Global Health), Dr Nirmala Nair (Ekjut, India), Professor Kishwar Azad (Peri-natal Care Project, Bangladesh), Professor Dharma Manandhar (MIRA, Nepal) and Florida Banda (MaiMwana, Malawi). Come and join us from 18.30 to 20.30 in room 407.

For information or to RSVP contact Ruth Duebbert on This email address is being protected from spambots. You need JavaScript enabled to view it.  or +44 (0)20 7700 6309, ext 204.

More information on the Women Deliver side events.

25/02/2013 : A Manifesto for Maternal Health Post-2015

On Jan 15—17, 2013, over 800 experts in maternal health came together in Arusha, Tanzania, to present the latest evidence on improving the quality of care for women during pregnancy and childbirth. The past 25 years of the safe motherhood movement have seen extraordinary successes—notably a 33% reduction in maternal mortality from 409,053 in 1990 to 273,465 in 2011. These achievements have motivated and mobilised a welcome new generation of political and financial commitments to maternal health.

But with the era of the Millennium Development Goals (MDGs) drawing to a close in 2015, a moment of uncertainty hangs over the fate of more than 200 million women who become pregnant each year. As the world moves towards the next set of development goals, will the gains of the past for women be protected, and can the unfinished business for the future be addressed? As a contribution to the process of redefining human development for women after 2015, participants at the Arusha conference supported writing a manifesto for maternal health based on the best available evidence, the lessons of safe motherhood from the past 25 years, and the more recent experience of the MDGs.  

The manifesto

• The global health community must build on past successes and accelerate progress towards eliminating all preventable maternal mortality within a time-bound period. To this end, a new and challenging goal for maternal mortality reduction is needed within the development goal framework for the post-2015 era, one that is led and owned by countries not donors.
• This maternal mortality goal must be broadened to embrace the progressive realisation of political, economic, and social rights for women. One critical lesson from the history of women's health is that maternal health will not be improved to its full potential by focusing on maternal health alone.
• As maternal mortality declines, the world must now focus on both prevention and treatment of maternal morbidities, the measurement of which is challenging but critical to tackle for the health, productivity, and dignity of the women involved.
• The successful framework of the continuum of care must be redefined to make women more central to our notions of reproductive, maternal, newborn, and child health. The continuum needs to be more inclusive of frequently neglected elements—eg, quality of care, integration with HIV and malaria programmes, non-communicable diseases, and the social determinants of health, such as poverty, gender disparities, sexual and gender-based violence, water and sanitation, nutrition, and transportation.
• The global health community must devise a responsive financing mechanism to support countries in implementing their plans to reduce maternal mortality and improve sexual and reproductive health.
• A much greater emphasis must be put on reaching the unseen women who are socially excluded because of culture, geography, education, disabilities, and other driving forces of invisibility. If we are serious about redressing gender and access inequities, we have to ask fundamental and difficult questions about the nature of our societies and the value, or sometimes lack of value, we ascribe to individuals, especially women, in those societies.
• One critically important element to address women's health and needs is attention to improving comprehensive quality of care. Respectful maternal health care for all women is an ethical imperative, not an option.
• The maternal health community must invite, include, and incorporate the voices of women themselves into writing the future of maternal health. Too often, women's voices are silenced, ignored, or reported only second hand. Women must be given the platform and power to shape their own futures in the way they wish.
• For the mother, her newborn child is a precious and indissoluble part of her life and her future. Maternal health outcomes cannot be fully addressed without attacking the appalling global toll of preterm births, preventable stillbirths, and newborn deaths.
• A critical gap that threatens the future health of women and mothers is the catastrophic failure to have reliable information on maternal deaths and health outcomes within and across countries. This gap in measurement, information, and accountability must be a priority now and post-2015.
• A tremendous opportunity lies in technology. Mobile and electronic health technologies must ensure that women are effectively and safely connected to the health system, from education to emergencies, referral for routine antenatal care to skilled birth attendance. Putting the right technologies in the hands of women offers one compelling opportunity to make empowerment of those women a reality.
• Finally, we must fulfil all of these actions sustainably, which means universal access to high-quality health services free at the point of demand, within a strong health system, supportive of the fully trained front-line worker—from family planning, to safe abortion, to emergency obstetric care, with respect for both providers and women.

The Lancet, Volume 381, Issue 9867, Pages 601 - 602, 23 February 2013

16/01/2013 : In India Preference for Sons Undermines Desire for Smaller Families

Despite a strong family planning programme and a growing desire for smaller families, women in India often have more children than they would like because of a longstanding preference for sons over daughters. A new study exploring this issue finds that continued childbearing driven by son preference accounts for 7% of all births in the country.

According to "The Desire for Sons and Excess Fertility: A Household-Level Analysis of Parity Progression in India," by Sanjukta Chaudhuri of the University of Wisconsin, women were more likely to stop having children if their last child had been a son rather than a daughter. The author also found a strong relationship between family size and the proportion of female children in a family.

Son preference has come into conflict with the desire for smaller families in many parts of South, East and Central Asia, where a much higher value is placed on men than on women. This analysis, which used data from India's 2005–2006 National Family Health Survey on women aged 35–49 who had at least one child, found that the desire for sons is a key driver of women having another child. Indian women without any sons are more likely to continue having children than those without any daughters. For example, women whose first child was a daughter were more likely to have another child than those whose first child was a son, and women whose first two children were daughters were more likely to have another child than those whose first two children were sons. As a result, Indian girls are likely to grow up in larger families than boys do; in such families, fewer resources are available to each child, and girls are likely to receive a smaller share of those resources than their brothers, leading to gender disparities in health, education and other outcomes.

Given that India is expected to become the world's most populous country by 2025, it is critical that government policies help families achieve their childbearing goals. To date, while programmes aimed at increasing women's education have been linked to declines in unwanted births, the preference for sons still leads couples to have larger families than they would like. The author highlights South Korea as an example of a country where urbanization and rapid economic development reversed an imbalance in the sex ratio through their impact on underlying social norms. Chaudhuri argues that it is imperative for government programmes to reduce the preference for sons by challenging perceptions that sons are more valuable than daughters and continuing to improve women's status in society.