Getting women to care: mixed–methods evaluation of a maternity care intervention in rural Nepal

Authors: Sharma, S., van Teijlingen, E., Simkhada, P.P., Hundley, V., Angell, C., Stephens, J., Sicuri, E. and Belizan, J.

Conference: 1st National Health Promotion Conference in Nepal

Dates: 30 March-1 April 2013


Background: The Buddhist charity Green Tara Trust (GTT) set up a program to improve the uptake of maternal care practices in rural Nepal via health promotion activities in the community over 5 years. The programme is novel because it seeks to improve maternal service uptake via bottom-up participatory methods in rural communities. This research aimed to compare the effectiveness of the GTT health promotion strategy, with standard care for mothers in a developing country community setting.

Methods: The research was a mixed-methods evaluation of a maternity care intervention in rural Nepal; conducted in collaboration with GTT. Data were collected using a controlled before-and-after, cross-sectional survey; with socioeconomic, cost and health uptake questions. A questionnaire-based interview was conducted with 833 women, with their last child less than 2 years old. Ethical approval provided by the Nepal Health Research Council.

Analysis: The relation between the number of ANC (antenatal care) visits, belonging to the intervention group, and the respondents’ background (education, household income & parity) was examined.

Results: The health promotion intervention appeared to improve ANC attendance. Low educational level, low household income, and multiparty were risk factors for non-attendance. The evaluation suggests that practice should be socio-culturally appropriate and inclusive not only of women but also their families; mother-in-laws’ and men’s participation should be sought.

Conclusions: These types of evaluations inform policy; findings can be used to shape policy to be ‘inclusive’ to those marginalised, for example rural communities in Nepal. Furthermore, maternal health promotion is central to achieving maternal health goals nationally and ought to be part of the nurse midwifery curriculum. Finally, funding was provided from Bournemouth University and the Santander Universities’ scheme.

Source: Manual

Preferred by: Edwin van Teijlingen