In this section, we are talking about specific research studies that have looked at women's groups who practice participatory learning and action as an intervention that can be studied. We'll look at the results of systematic reviews and meta-analyses, which may be very familiar terms to some of you, less so to others. Briefly, a systematic review is a summary of the best available research on a specific question. This is done by synthesizing the results of several studies. A meta-analysis is a method of combining results from different studies. A summary which allows us to see with very large numbers whether a treatment or intervention has an effect on an outcome, and what degree of effect it has. Now, we already know that newborns, babies from the time of birth until they're one month old, comprise the largest proportion of children who die before they are five years old. There are well known actions to prevent newborn deaths, and some think that half of the numbers of deaths could be prevented by tetanus immunization of the mothers, clean and skilled care at birth, resuscitation of the newborn, exclusive breastfeeding, clean care of the umbilical cord, and management of infections in newborns. A systematic review conducted and reviewed in the Cochrane database has shown that packages of interventions that are delivered by community health workers or traditional midwives, sometimes called traditional birth attendants, can improve the health of mothers and newborns. If you are not familiar with a Cochrane Review, they are systematic reviews of primary research in human healthcare and health policy, and they are internationally recognized as the highest standard in evidence-based healthcare. Basically, they look at treatments, which in healthcare we call interventions, to determine if one treatment works better than another or if it will do more harm than good. To get a better understanding of Cochrane Reviews, I encourage you to look at their website. Anyway, a Cochrane Review published in 2010 found that a decrease of 25% of maternal morbidity or illness was found in communities who did use community workers to deliver interventions, compared to those communities who didn't. In those same communities, referrals to health facilities for pregnancy-related complications increased by 40%. Newborn deaths were decreased by 24%. Let's explore in more detail some of the specific projects and places where community mobilization and participation made a difference in the health of mothers and babies. The first project we'll talk about has been a model for many others around the world, and it's called the WARMI Project. The WARMI Project was conducted from 1990 to 1993 in 50 communities in Bolivia. Initially developed by the Bolivian office of the NGO Save the Children, and supported by the United States Agency for International Development in their MotherCare project. The WARMI Project organized already existing women's groups in the communities to identify what was needed to improve their reproductive health. They use the same PDSA cycle that we spoke about in the previous segment, the Plan, Do, Study, Act cycle. As women named what they needed to improve care, there were behavioral changes that resulted. More women went to get prenatal care, more women breastfed, more women received immunizations, and more women recognized importance signs of health in their newborn than they had previously to the WARMI Project. It was very successful. In fact, the death rate of newborns at the time of birth decreased by almost 50%. Although the evaluation research on the WARMI Project could not determine that these improvements were caused exclusively by the WARMI process, it definitely is fair to say that at least some of the positive impact was related to WARMI. One of the things that the Bolivian women were happy about was the chance to speak to each other about things they had never spoken about before. The biggest behavior change from WARMI was that the participation of women in women's organizations actually doubled. After the initial project was completed by 1998, the Bolivian government as well as other non-governmental organizations repeated the process in eight of the nine departments in Bolivia. After the success of WARMI, a subsequent project in Bolivia, with a Bolivian NGO ProSalud, did another project, and used similar community participation strategy, where women health promoters were trained to become trainers of other women. The training related to reproductive health including contraception, pregnancy and delivery, sexually transmitted infections, self esteem, and reproductive rights. They also trained women in managing basic projects in negotiation and in advocacy. Then, the women began active networks with each other and formed committees to defend women in their community against sexual violence. These resulted in behavioral changes. More women would come for pap screening and family planning methods. The cost of the project was also important to note. It only cost $24 per woman for training.
