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Reaching the poor with health interventions: programme-incidence analysis of seven randomised trials of women's groups to reduce newborn mortality in Asia and Africa
  1. Tanja A J Houweling1,2,
  2. Joanna Morrison1,
  3. Glyn Alcock1,
  4. Kishwar Azad3,
  5. Sushmita Das4,
  6. Munir Hossen3,
  7. Abdul Kuddus3,
  8. Sonia Lewycka1,
  9. Caspar W Looman2,
  10. Bharat Budhathoki Magar5,
  11. Dharma S Manandhar5,
  12. Mahfuza Akter3,
  13. Albert Lazarous Nkhata Dube6,
  14. Shibanand Rath7,
  15. Naomi Saville1,
  16. Aman Sen5,
  17. Prasanta Tripathy7,
  18. Anthony Costello1
  19. for the EquiNaM group
    1. 1Institute for Global Health, University College London, London, UK
    2. 2Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
    3. 3Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
    4. 4Society for Nutrition, Education and Health Action (SNEHA), Urban Health Centre, Shahunagar, Dharavi, Mumbai, Maharashtra, India
    5. 5Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
    6. 6MaiMwana Project, Mchinji, Malawi
    7. 7Ekjut, Chakradharpur, Jharkhand, India
    1. Correspondence to Dr Tanja AJ Houweling, Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK; a.j.houweling{at}


    Background Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa.

    Methods We conducted a secondary analysis of seven randomised trials of participatory women's groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70 574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results.

    Results Socioeconomic differences in women's group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant and interesting to all socioeconomic groups. Local facilitators ensured inclusion of poorer women. Embarrassment and family constraints on movement outside the home restricted attendance among primigravid women. Reproductive health discussions were perceived as inappropriate for them.

    Conclusions Community-based women's groups can help to reach every newborn with effective interventions. Equitable intervention uptake is enhanced when facilitators actively encourage all women to attend, organise meetings at the participants’ convenience and use approaches that are easily understandable for the less educated. Focused efforts to include primigravid women are necessary, working with families and communities to decrease social taboos.

    • Health inequalities

    This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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