Community Involvement in Early Postpartum Care

Community Involvement in Early Postpartum Care A Consultative Research from Mandiana, Guinea Susan Otchere Maternal Health Advisor Save the Children US June 8, 2005 Mini-University Outline • • • • • Background Partnership Objectives Early Post Partum Care Defined Behavior Change Approaches: – Consultative research – “Concept testing” • Results Background  Save the Children’s Community Health Initiative to improve Maternal and Newborn Survival in Guinea     Improve health provider competency Strengthen delivery by TBAs Improve access to and increase use of early postpartum care Improve household and community knowledge and care-seeking Partnership • The Change Project (AED/The Manoff Group) Collaborated with field partners, to identify, develop and apply innovative behavior change tools and approaches to improve maternal and newborn health and nutrition behaviors • Save the Children US (May 2001-2002) A research activity proposed To test participatory model to increase the use of early postpartum care (EPPC) by mothers and newborns Early Post Partum Care (EPPC)  EPPC includes first two weeks after birth  WHO recommends up to 4 contacts with new mothers (1, 3, 7, 14)  Saving Newborn Lives Initiative recommends the first visit should take place within 72 hours Research Objectives  Provide insight into the factors underlying care-seeking decision making during the early postpartum period in 2 rural districts in Mandiana Province, Upper Guinea  Test the concept and acceptability of introducing early postpartum home visitors (EPPVs) Research Setting  Mandiana and Koundian districts (Mandiana Province)  Assisted delivery in Mandiana Province (Guinea DHS report 1996-1999) „ Doctor: 5% „ Trained nurse or midwife: 15% „ TBA: 29% „ Relative: 43% „ No one: 8% Approaches used „ “concept testing” „ consultative research “Concept testing” of the Early Postpartum Visitor (EPPV) Generic Framework For Early Postpartum Care Options or or EPPV Home visits 1st week x 3 EPPC “Depot” in Community EPPV Facility-Based EPPC (skilled provider) Consultative Research 1. Communities and households not only as respondents in the qualitative research, but also in the design, testing and modification of new behaviors to increase acceptability and adoption of new behaviors Negotiating behavior change – talking with women, families and communities to develop realistic behaviors and determine specific “conditions of acceptability” for EPPV 1 and 2 - done, before behaviors, strategies, and interventions are decided 2. 3. Qualitative methods used in consultative research In-depth Interviews Target Population Women who had normal birth in last six months Women who had obstetric complications in past six months Elder female family influentials Traditional birth attendants Skilled Providers Husbands/male partners of women who had birth in past six months Village health committee members Total Mandiana 5 5 5 3 5 Koundian 5 5 5 3 2 Total 10 10 10 6 7 1 1 23 20 43 2 1 1 2 2 2 4 Focus Group Discussions Mandiana Koundian Total Results: Common barriers to EPP Care Family perspective: • Lack of knowledge about the importance of routine early postpartum care • Lack of knowledge of danger signs • Costs of care, distance, transportation • Embarrassed to be examined by skilled provider • Poor attitude of skilled providers at facilities • Cultural taboos (djoubabato tana-cultural constraints to new mothers leaving home after birth) Results: Common barriers to EPP Care Health provider perspective: • Unaware of need for and content of routine early postpartum care (within one week of birth) • No motivation (financial, professional) to give additional services • Unwilling to make home visits for EPP care • Do not see community outreach as part of their role „ providers not trained in management of early postpartum emergencies Results: “Conditions of acceptability” of the EPPV Family perspective  „ „ „ „ TBAs as EPPV for routine early postpartum care and early detection of complications Trained health provider as EPPV visitor capable of treating EPP emergencies EPPV was well trained to conduct such a visit EPPV was chosen and supported by the community EPPV was “kind, patient, welcoming, friendly, available and a good communicator” Results: “Conditions of acceptability of the EPPV Health provider and VHC perspective •Will endorse EPPV concept if EPPV program has clear guidelines Considerations for interpreting results  Small sample size (83 respondents)  Save the Children presence - 5 years of successful program interventions to strengthen maternal care provision  Need to test tools in other settings Follow Up: Community Dissemination and Planning  VHC members, families, community and health providers discussed research findings and negotiated an acceptable EPPV intervention design Community priorities  Train TBAs to provide routine postpartum care  Reinforce care-seeking for obstetric and newborn emergencies  Develop activity to facilitate better communication between husbands and wives during pregnancy, childbirth CS 18 activities (October 2002)  Community priorities TBA curriculum revised to include:  Train TBAs to act as “link workers” to increase access to EPPC  First postpartum visit by TBA in first week after birth TBA refers mother and newborn when problem is detected  Health workers trained in postpartum care  Community capacity strengthened to manage obstetric emergency funds and transport schemes Preliminary findings - CS 18 Objective for postpartum care: 60% of mothers will receive at least 2 post-natal visits in the first week after birth a. October ‟ December 2003 Postpartum coverage: 48% b) October ‟ December 2004 Postpartum coverage 79% Summary Testing new concepts before implementing programs improves adoption of recommended and desired behaviors