Gender influences on child survival, health and nutrition: a ... - Unicef

<strong>Gender</strong> Influences On Child Survival, Health And Nutrition: A Narrative Review
2.2 ADDRESSING COMMUNITY PARTICIPATION
The review has demonstrated that health service users face multiple barriers to facility care, some of
which are specifically linked to dimensions of gender. As the diagram above demonstrates, women
experience time poverty due to their heavier burden of ‘reproductive’ care, which is often coupled with
other duties such as paid employment inside or outside the home. On the other hand men may feel
discouraged to attend facilities with young children as communities and the facilities themselves often
view maternal and child health care as a purely ‘female’ domain. Beyond these gender-related factors,
poor and isolated communities suffer through lack of access to primary health care facilities and lack of
transport or, indeed, financial resources, to travel to distant facilities. In turn, women’s lack of financial
independence and lack of freedom to travel may exacerbate these factors further. Communities may
benefit then from health services that are delivered through more accessible and sustainable
mechanisms and that seek to engage community members within their local contexts. Outlined below
are two examples of projects which have sought to engage with communities through participatory
methods.
A cluster-randomised trial of a participatory learning and action cycle found positive child survival
outcomes for this type of intervention, which focused on mobilizing women’s groups in Jharkand and
Orissa, eastern India (Rath et al. 2010). The intervention was carried out in 18 cluster sites, 12 of which
were in isolated rural communities, where newborn health outcomes were particularly poor. In these
communities women have little access to primary health care facilities and delivered in 80% of cases,
without a skilled birth attendant. The intervention involved 20 meetings with women’s groups based on
participatory learning and action methods. The intervention sought to address supply-side and demandside
issues by combining learning activities such as participatory games and strategies with strategies to
address health funds, stretcher schemes, production and distribution of clean delivery kits, and home
visits.
The intervention led to a 45% reduction in neonatal morality in the last two years of the intervention,
which the study was largely due to improvements in safe practices for home deliveries. The authors
hypothesised that this improvement was based on the following six interrelated factors: (1)
acceptability; (2) a participatory approach to the development of knowledge, skills and ‘critical
consciousness’; (3) community involvement beyond the groups; (4) a focus on marginalised
communities; (5) the active recruitment of newly pregnant women into groups; (6) high population
coverage.
An important aspect of the intervention’s success was that other members of the community became
involved in the groups throughout its implementation, leading to broader learning and engagement with
other households members such as husbands and adolescent girls or unmarried women thus reinforcing
learning more widely. However the authors point out this broader engagement was at times
challenging, when facilitators had to address sensitive topics in the presence of men, for example.
Aubel et al. (2004) provide an evaluation of an intervention focused on grandmothers’ involvement in
improving maternal and child nutrition (Aubel, Touré & Diagne 2004). The authors usefully identify
ways in which grandmothers have been left out of the equation in mother and child health
programming, due to perceptions that they are not influential in household decision-making, or that
they are associated with ‘traditional’ remedies considered harmful, or that they are incapable of
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