BHUBANESWAR: Participatory approach to antenatal and postnatal care facilitated by Accredited Social Health Activists (ASHAs) can bring about a substantial reduction in neonatal mortality rates in the community.
Involvement of ASHAs with local women groups through a cycle of participatory learning and action (PLA) meetings has achieved a 31 per cent reduction in neonatal mortality rate in some highly vulnerable districts of Odisha and Jharkhand, a study published in the prestigious Lancet journal has revealed.
The study led by Jharkhand-based Ekjut with support from Institute for Global health, University College of London and Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands was conducted in Mayurbhanj and Raygada districts in Odisha and Ranchi, Godda and Khunti in Jharkhand between September, 2009 and December, 2012.
A population of 1.56 lakh divided into 30 clusters across the five districts was covered in the study. The clusters were further divided into two groups of 15 each that were assigned to Intervention or adoption of participatory approach through women’s groups and Control without any group formation respectively.
The activity period from January, 2011 to December, 2012 included 7219 births in both the clusters and observed a 31 per cent reduction in neonatal mortality in the Intervention group.
The positive change has been attributed to the PLA approach wherein women’s groups were formed and underwent a four-phase cycle of meetings, discussions and interventions facilitated by ASHAs. Groups met to identify and prioritise problems in pregnancy, delivery and the postnatal period and decided on strategies to address them.
The Intervention group not only saw an increase in institutional delivery but also experienced that women were better prepared to follow early and exclusive breastfeeding and thermal care practices, thereby preventing complications and deaths in low birth weight and pre-term babies, the study led by Prasanta Tribath of Ekjut stated.
“Further, the group meetings enabled ASHAs to increase their contact with most marginalised women in the perinatal period. Participatory group meetings enable soft targeting of poorest women as they are open to all, held at times decided by the women themselves and take place in the remotest hamlets. Thus, the ASHAs could promote birth preparedness and facility births among those who need it the most, thereby contributing to mortality reduction,” the paper says.
The WHO has set a target for reducing neonatal mortality rate to 12 per 1000 live births by 2030. The ASHAs can successfully reduce India’s high NMR through the PLA approach. “This is a scalable community-based approach to improving neonatal survival in rural, under-served areas of the country,” the study has stressed.