Community Communication Emergency Referrals Save Rural Women, the Greatest Equity Gap

Presenter: Susan Aradeon, formerly Johns Hopkins University Center for Communication Programs

The greatest safe motherhood equity gap is experienced by poor, rural women whose lives cannot be saved by the SBA delivery strategy alone.  PRRINN-MNCH, a DfID/UKaid and Government of Norway program in northern Nigeria, adopted the 3-Delay model by integrating Community Communication Emergency Referrals (CCERs) into the health system. Evidence from the household surveys and facility data revealed a 16.8% MMR reduction in the intervention districts within four years whereas the control districts remained virtually unchanged. An estimated one quarter of this reduction is attributable to community referrals.  CCER is an equitable approach for increasing Met Need for EmOC because virtually every timely, community referral for emergency maternal care results in a life saved whereas only 15% or one in every six births delivered by an SBA requires lifesaving care. The intervention community baseline and endline KAP recorded rapid increases in normative knowledge, attitudes and social capital as well as substantial progress towards healthier behavior norms within 14 months. Communities were saturated with volunteer led discussions using communication body tools that empowered them to learn, recall, share and decide about appropriate behaviors. More than 30% of respondents reported participating in discussions which contributed to more discussions with spouses, friends and relations.  Eighty percent became aware of the safe motherhood support structures established by their community: community volunteers, savings fund, drivers and blood donors.  A normative majority (77.5%) believed that the community held husbands responsible for saving maternal lives versus 32.2% previously.  Over half of the women referred by the community received a grant or loan. By empowering community members to become the communicators, the Community Communication intervention rapidly catalyzed the formation of a rural community norm of social responsibility that saves maternal lives through timely EmOC access.