Effects of community-based health promotion on antenatal care utilization in Nepal: Controlled before and after study
Authors: Simkhada, P., van Teijlingen, E., Stephens, J., Gurung, S. and Sharma, S.
Conference: Second Global Symposium on Health Systems Research
Dates: 31 October-2 November 2012
A community based controlled before and after study (CBA) was performed in rural Nepal during 2008-2011. The study covered four communities (2 intervention/2 control) with s total population of 20,000. Intervention activities were implemented by 2 trained health promotors (HPs) over a 3 year period. The major interventions included women group formation and training, home visit, baby blanket distribution for those who complete the 4 ANC visits, health massages through mass event during local festival, and support to local health facilities. Interventions focused on promoting early ANC attendance and completing four sessions. This paper analyses the impact of the interventions on the utilization of antenatal care and women’s decision making power.
All married women in the reproductive age group (15-49 years old) residing in the study area who had delivered their last baby within the last 24 months preceding the study were interviewed using a structured questionnaire. A total 412 women (208 in intervention and 204 in control) were interviewed in 2008 and 421 women (217 in intervention and 204 in control) were interviewed in 2011 for evaluation.
Majority of intervention women had at least one ANC check-up during their last pregnancies in compare to control community. Similarly, the percentage of women who had minimum of four ANC check-ups prior to delivery had increased in both communities but there was a greater increase in the intervention areas. Women’s decision making power for ANC improved significantly more in the intervention community compare to the control community.
The study has demonstrated the effectiveness of community-based health promotion intervention in promoting the utilization of antenatal care and women’s decision-making. This improvement is attributed to the HP's home visits, women groups, incentives (baby blanket) and the close collaboration with existing health services and the wider community.
Preferred by: Edwin van Teijlingen