EquiNaM: building evidence to support equitable improvement in newborn and maternal health

Millennium Development Goals

Progress towards the Millennium Development Goals (MDGs) has been highly uneven. Poor and otherwise disadvantaged groups lag behind their more fortunate compatriots for most MDGs. To make things worse, effective interventions are known, but rarely reach those who need them most. Unfortunately, little is known about how to effectively reach poor and otherwise disadvantaged groups, and how to address socio-economic inequalities in mortality.

EquiNaM uses an integrated approach to support an equitable improvement in newborn and maternal health by (i) generating evidence using high-quality data and randomised controlled trials and (ii) learning from and engaging with stakeholders to support the uptake of our newly generated evidence base.

Maternal and newborn mortality studies

EquiNam builds on a global network of demographic surveillance sites that provides some of the largest population-bases of prospectively collected data for maternal and newborn mortality studies in low and middle income countries. We use data from six sites, in India (Mumbai and Orissa & Jharkhand), rural Nepal (Dhanusha, and Makwanpur districts), rural Bangladesh and rural Malawi, with a combined population of over 2 million.

The surveillance sites were set up to evaluate the impact of community mobilisation interventions on neonatal mortality. The intervention consists of women’s groups, facilitated by a local woman, that meet monthly. The facilitator leads the groups through a participatory action cycle, in which they identify and prioritise maternal and newborn health problems in the community, collectively select relevant strategies to address them, implement the strategies, and evaluate the results.

Principal Investigator

Tanja AJ Houweling, PhD

Involved Researchers & Departments

• Department of Public Health, Erasmus MC University Medical Center Rotterdam
• UCL Institute for Global Health, London, UK
• MaiMwana, Mchinji, Malawi
• Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh
• Society for Nutrition, Education and Health Action (SNEHA), Mumbai, India
• Ekjut, Chakradharpur, India
• Mother and Infant Research Activities (MIRA), Kathmandu, Nepal

Countries Involved 

India, Nepal, Bangladesh, Malawi

Funding 

ESRC & DFID

Publications

• de Jonge E, Azad K, Hossen M, Kuddus A, Manandhar DS, van de Poel E, Roy SS, Saville N, Sen A, Sikorski C, Tripathy P, Costello A, Houweling TAJ. Socioeconomic inequalities in newborn care during facility and home deliveries: a cross sectional analysis of data from demographic surveillance sites in rural Bangladesh, India and Nepal. Int J Equity Health 2018; 17(1): 119.
• Thongkong N, van de Poel E, Roy SS, Rath S, Houweling TA. How equitable is the uptake of conditional cash transfers for maternity care in India? Evidence from the Janani Suraksha Yojana scheme in Odisha and Jharkhand. Int J Equity Health 2017; 16(1): 48.
• Houweling TAJ, Looman CWN, Azad K, Das S, King C, Kuddus A, Lewycka S, Manandhar DS, Sah More N, Morrison J, Phiri T, Rath S, Rosato M, Sen A, Tripathy P, Prost A, Osrin D, Costello A. The equity impact of community women's groups to reduce neonatal mortality: a meta-analysis of four cluster randomized trials. Int J Epidemiol 2017.
• Houweling TA, Joanna Morrison, Kishwar Azad, Glyn Alcock, Mahfuza Akter, Jyoti Bamjan, Bharat Budhathoki Magar, Sushmita Das, Bedowra Haq Aumon, Md. Munir Hossen, Abdul Kuddus, Sonia Lewycka, Caspar W. Looman, Florida Malamba, Dharma S Manandhar, Riddhima Metha Basiya, Albert Nkhata, Shrijana Pathak, Tambosi Phiri, Shibanand Rath, Mikey Rosato, Kabita Sah, Naomi Saville, Aman Sen, Neena Shah More, Sweta Surve, Rinku Tiwari, Prasanta Tripathy, Collins OF Zamawe, David Osrin,  Anthony Costello. Reaching the poor with health interventions: programme incidence analysis of seven randomised trials of women’s group reproductive health interventions in Asia and Africa.J Epidemiol Community Health. doi:10.1136/jech-2014-204685 
• Glyn Alcock, Sushmita Das, Neena Shah More, Ketaki Hate, Sharda More, Shanti Pantvaidya, David Osrin, Tanja AJ Houweling. "Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study." BMC Pregnancy & Childbirth. 15:231. DOI 10.1186/s12884-015-0661-6.
• Houweling TAJ, Morrison J, Azad K, Manandhar DS, Alcock G, Shende S, Tripathy P, Costello A. "How to reach every newborn: three key messages."  Lancet Global Health. 2014;2(8): e436–e437.
• Melissa Neuman, Glyn Alcock, Kishwar Azad, Abdul Kuddus, David Osrin, Neena Shah More, Nirmala Nair, Prasanta Tripathy, Catherine Sikorski, Naomi Saville, Aman Sen, Tim Colbourn, Houweling TA, Nadine Seward, Dharma S Manandhar, Bhim P Shrestha, Anthony Costello and Audrey Prost. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India, and Nepal. BMJ Open. 2014;4:e005982 doi:10.1136
• de Jonge H.C.C., Azad K., Seward N., Kuddus A., Shaha S., Beard J., Costello A., Houweling TA, Fottrell E. "Determinants and consequences of short birth interval in rural Bangladesh: a cross-sectional study." BMC Pregnancy and Childbirth. 2014;14:427. DOI 10.1186/s12884-014-0427-6
• Houweling TA, Tripathy P, Nair N, Rath S, Rath S, Gope R, Sinha R, Looman CW, Costello A, Prost A.  The equity impact of participatory women's groups to reduce neonatal mortality in India: secondary analysis of a cluster-randomised trial. Int. J. Epi.2013;42:520-32
  • Commentary on the above publication: Victora CG. Commentary: Participatory interventions reduce maternal and child mortality among the poorest, but how do they work? Int J. Epidemiol. 2013;42:503-05.
• Houweling TAJ, Prost A, Tripathy P, Nair N, Costello A. Authors’ Response: The equity impact of participatory women’s groups to reduce neonatal mortality in India: secondary analysis of a cluster-randomized trial. Int. J. Epi. 2013; doi: 10.1093/ije/dyt118
• Audrey Prost, Tim Colbourn, Nadine Seward, Kishwar Azad, Arri Coomarasamy, Andrew Copas, Houweling TA, Edward Fottrell, Abdul Kuddus, Sonia Lewycka, Christine MacArthur, Dharma Manandhar, Joanna Morrison,, Charles Mwansambo 8, Nirmala Nair, Bejoy Nambiar, David Osrin,, Christina Pagel, Tambosi Phiri, Anni-Maria Pulkki-Brannstrom, Mikey Rosato, Jolene Skordis-Worrall, Naomi Saville, Neena Shah More, Bhim Shrestha, Prasanta Tripathy, Amie Wilson  and Anthony Costello. Women’s groups practising participatory learning and action to improve maternal and newborn health in resource-limited settings: systematic review and meta-analysis. Lancet. 2013; 381: 1736–46.
• Younes L, Houweling TA, Azad K, Costello A, Fottrell EF. Estimating coverage of a women's group intervention among a population of pregnant women in rural Bangladesh. BMC Pregnancy and Childbirth. 2012; 12:60.
• Nahar T, Azad K, Aumon BH, Younes L, Shaha S, Kuddus A, Prost A, Houweling TA, Costello A, Fottrell E. Scaling up community mobilisation through women's groups for maternal and neonatal health: experiences from rural Bangladesh. BMC Pregnancy Childbirth. 2012;12:5.