Empowering rural women leaders to promote maternal health in Cusco, Peru: test of a new teaching method

The following is the final installment of a series of project updates from Future Generations. MHTF is supporting their project, Using Pregnancy Histories to Help Mothers, based in Peru. More information on MHTF supported projects can be found here.

 

Written by: Future Generations

 

Rural women need to be empowered to make better decisions about home health behaviors. Frequently, in poor communities where women’s health needs are greatest, they are the least empowered: so the question is — how to support the critical transition from disempowered to empowered? The hypothesis of Future Generations was tested with women leaders from rural Andean communities of Peru through an operations research project entitled “Between Us (Women): Sharing Pregnancy Histories as Part of Community Education for Maternal and Neonatal Health,” in which processes used to train women leaders were designed to empower them as change agents. Women selected as community health promoter volunteers (Women Leaders) by other women in their own community, are asked to share their experiences from each of their own pregnancies, births, postpartum periods, breastfeeding experiences, and other issues related to maternal and child health, in terms of what they did, what they felt, if they sought help, what was the outcome, and other aspects. These experiences are used as the basis of subsequent training, through identifying and analyzing local customs and practices, identifying positive and negative beliefs and behaviors, and learning from each other. A pilot project using this method implemented in Afghanistan by Future Generations found a significant decline in child mortality in communities where this method was implemented.

 

A cluster-randomized controlled trial was used to adapt and test the method in Peru. Women leaders in half of the selected communities were trained using the innovative method; for those in the other half of matched randomly-assigned communities, standard health promoter teaching methods were used. We first implemented a baseline survey of mothers of children under one year of age, and oriented communities with selection and designation of Women Leaders. Then we implemented a series of workshops on six topics (pregnancy, childbirth/postpartum, newborn, breastfeeding, infant diarrhea, infant pneumonia) conducted over a period of eight months with 75 women leaders divided into four training groups (two experimental groups and two control groups). In the latter half of the project, in-depth interviews and focus groups were conducted in communities with women leaders, mothers of children under age one, and community leaders by an anthropologist fluent in the local language of Quechua to assess community attitudes toward Women Leaders.

 

Results of pre and post-tests for each training module showed greater improvements in experimental groups of Women Leaders. Results of qualitative community studies showed that, comparing experimental and control groups, rural women learned faster after sharing their experiences and learning from their previous actions. They acquired confidence hearing other women share their stories and difficulties, overcame nervousness, fear, and shame of speaking in public, and became more communicative and able to teach other women. They used the same method in their own communities to generate trust among women by telling their stories and asking mothers to tell theirs. Results of the quantitative household surveys conducted at baseline and at the end of project showed that experimental communities had greater changes in maternal behaviors including a significant decrease in the prevalence of child diarrhea, while control communities had more improvements in levels of maternal health knowledge. We conclude that methods used to train rural Women Leaders make a difference in their level of self-confidence, motivation and empowerment to become change agents in their communities. At the same time, any training at all of women leaders is effective to begin a change process for women in their communities. As a new method for training illiterate female health promoters, the “Sharing Pregnancy History” methodology is both effective and is easily learned by local health sector professionals who are usually in charge of training health promoters.

 

Facilitator manuals were produced on six key MCH topics for use in scaling-up the methodology: Introduction to Community Leadership and Empowerment; Pregnancy; Birth and Postpartum; Newborn; Breastfeeding; Infant Diarrhea; Infant Pneumonia.

 

This research was conducted by Future Generations with partial support through a subgrant from the Maternal Health Task Force with funding from the Bill & Melinda Gates Foundation.

 

The “Sharing Pregnancy History” method is currently being further tested by Future Generations with women leaders in the Huánuco region of Peru in a cluster-randomized controlled trial as part of a larger integrated maternal neonatal child health and nutrition project, with support from USAID Child Survival and Health Grant Program during the period 2010-2014.