A Lancet study in 2013 used a factorial, cluster-randomised controlled trial to determine the effect of women’s groups and peer counselling on health outcomes and behaviors in rural Malawi. Those assigned to the women’s group intervention held 20 meetings over the course of 4 phases, accompanied by a facilitator. They identified and prioritized maternal and child health problems and came up with and implemented strategies to address them. The second part of the approach involved female peer counselors who identified pregnant women in their communities and made five home visits during and after pregnancy. They raised awareness about a range of health practices such as exclusive breastfeeding, infant care and family planning.
Lewycka et al. (2013) found both interventions impressive. In adjusted analysis, their results suggested that women’s group interventions in areas without peer counselling interventions reduced maternal mortality by 74%, perinatal mortality by 33%, neonatal mortality by 41% and infant mortality by 28% in years 2 and 3. There was no effect in areas with peer counselling. Peer counselling interventions in areas without women’s groups reduced infant mortality by 36% and overall infant morbidity by 42%. Exclusive breastfeeding increased, but the increase was only significant in areas with the women’s group intervention.
The study also found both approaches to be cost-effective. “The cost of women’s groups was US$114 per year of life lost (YLL) averted and that of peer counsellors was $33 per YLL averted, using stratified data from single intervention comparisons.”
