Grassroots Efforts Reduce Newborn Deaths in Northern India (web article)

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A community-based program in rural India that reduced a region’s neonatal mortality by 50 percent is the subject of a new video produced by the Global Health Council. “Saksham Shivgarh: A Community Empowerment and Essential Newborn Care Program in Rural India,” was developed by researchers in the Johns Hopkins Bloomberg School of Public Health’s Department of International Health. The program dramatically reduced the number of newborn deaths in the Uttar Pradesh region by promoting newborn care practices through community mobilization and behavior change communications.

Neonatal deaths in India exceed one million annually, with over 25 percent occurring in Uttar Pradesh, the most populous state. More than 80 percent of infant deliveries take place in the home, where women are out of reach of the formal health care system. As a consequence, most of the newborn deaths happen in the home.

The Bloomberg School of Public Health program recruited highly motivated community health workers and volunteers in the villages of Uttar Pradesh to promote a package of essential newborn care interventions among the population of approximately 120,000. The interventions included birth preparedness, clean delivery, hygienic umbilical cord care, skin-to-skin care (holding the baby close against the mother’s chest), breastfeeding and keeping the baby warm. Community health workers delivered the educational messages to pregnant women, their family members and key community members in a manner relevant to the local culture. They visited homes twice during the antenatal period and again within the first day of birth and three days after delivery.

The program focused on the power of the community to bring about change, without using top-down, highly medical interventions. Gary Darmstadt, MD, MS, director of the International Center for Advancing Neonatal Health and associate professor in the Bloomberg School’s Department of International Health, said, “We set about convincing the community that newborn health is where it all begins, that it sets the stage for the rest of their lives. The community became empowered with the knowledge and skills to target behaviors and reduce newborn deaths.”

The program began with field work in May 2003; final evaluation was completed in December 2006. The results were dramatic and quick: neonatal mortality was reduced by half over the first 18 months of the program. Skin-to-skin care for the newborns increased from 2 percent to universal acceptance. Initiation of breastfeeding on the first day increased from 21 percent to 75 percent.

Besides providing insight into how community health workers can help to substantially lower neonatal mortality in low-resource settings, the “Saksham Shivgarh: A Community Empowerment and Essential Newborn Care Program in Rural India,” provided an important forum for collaborating with the Government of Uttar Pradesh and other institutions in India. Those partnerships will continue in the program’s next stages, which will focus on providing technical assistance and evaluation for further initiatives on newborn health integrated with maternal and child health.

The International Center for Advancing Neonatal Health (ICANH) was established in 2005 to foster the development of innovative approaches to neonatal health that are integrated with programs and health systems in developing countries. This study was conducted in collaboration with King George Medical University in Lucknow, India. Support was provided by the Global Research Activity Cooperative Agreement, USAID India, and the Saving Newborn Lives Initiative of Save the Children-US (through a grant from the Bill and Melinda Gates Foundation).--Sharon Fisher