The Equity Impact of Community Women’s Groups to Reduce Neonatal Mortality: A Meta-Analysis of Four Cluster Randomized Trials

Session: Women’s Groups Working Together to Save Newborn Lives and Improve Maternal and Child Health and Nutrition

Presenter: Kishwar Azad, Diabetic Association of Bangladesh Perinatal Care Project
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Background: Socio-economic health inequalities are substantial in most countries. Little is known about what works to remedy this. Trials in Asia and Africa have shown a strong impact of community women’s groups on neonatal mortality (NMR) when coverage is high, but their equity impact remains unknown. We describe and explain the equity impact of this intervention across socio-economic strata.

Methods: We conducted a secondary analysis of four randomised trials in Nepal, India, Bangladesh, and Malawi. We estimated intervention effects on NMR and health behaviours for lower and higher socio-economic strata using logistic regression analysis. Differences in effect between socio-economic strata were tested. A meta-analysis was done for all trials combined.

Results: The analysis included 69,119 live births and 2,505 neonatal deaths. The intervention strongly reduced NMR in lower (55-64% reduction depending on the measure of socio-economic position used) and higher (36-45%) socio-economic strata. The intervention was pro-poor and did not show evidence of ‘elite-capture’: among the most marginalized populations NMR in intervention areas was 64% lower than control areas, compared with 36% lower among the less marginalized in the last trial year. The intervention strongly improved home care practices, with no systematic differences in effect between socio-economic strata.

Conclusion: Community women’s groups improve the survival of all newborns, especially among disadvantaged groups but also among the better-off. Groups may reverse the inverse-care law and contribute to an equitable reduction in neonatal mortality across socio-economic strata.