This World Health Organization (WHO) document updates the 2003 "Working with individuals, families and communities to improve maternal and newborn health", or "Individuals, Families and Communities (IFC) Framework", in the areas of evidence for key interventions and for community participation. The objective of this guideline document is to "consolidate the evidence and make recommendations for effective health promotion interventions to improve maternal and newborn health outcomes, particularly to increase seeking skilled care during pregnancy, childbirth and after birth." It is written for health programme managers in governmental and nongovernmental organisations (NGOs), and policy-makers working in maternal and infant health.
Recommendations, in brief, include:
- Birth Preparedness and Complication Readiness (BPCR) is an intervention delivered to the woman, and possibly her family and community, by the health care provider or a community health worker to increase awareness of BPCR. "Programmes often provide education materials or other visual aids with BPCR information or may implement mass media campaigns with BPCR messages. A BPCR plan contains the following elements: the desired place of birth; the preferred birth attendant; the location of the closest facility for birth and in case of complications; funds for any expenses related to birth and in case of complications; supplies and materials necessary to bring to the facility; an identified labour and birth companion; an identified support to look after the home and other children while the woman is away; transport to a facility for birth or in the case of a complication; and identification of compatible blood donors in case of complications."
- Male involvement interventions for maternal-neonatal health (MNH) programmes have directed efforts to "harness the support and active involvement of men for improved MNH outcomes. There are different models and rationales for seeking to involve men, including a view of men as gatekeepers and decision-makers for prompt access to MNH services both at the household and community levels; men as responsible partners of women and as an important sub-population within the community; the need to address men’s own sexual and reproductive health needs; and men’s preference to be involved as fathers/partners. Interventions often include mass media campaigns, community and workplace-based outreach and education for men only or for men and women together, home visits and facility-based counselling for couples, groups or men only." Care is recommended in promoting women's choices and autonomy within these programmes.
- Partnership with traditional birth attendants (TBAs) "are considered an important ally for health education and social support and can provide a positive link between women, families, communities and the formal health care system." Thus, there is a recommendation for work with TBAs for promotion and monitoring of maternal and newborn healthcare behaviours and services, as social supports during labour and delivery overseen by a skilled birth attendant and as trained administrators of misoprostol to prevent post-partum haemorrhage.
- Providing culturally appropriate skilled maternity care through ongoing dialogues with communities that ensure the meaningful inclusion of women's voices is recommended to "incorporate acceptable and respectful care, trained service providers, employed mediators and interpreters, and ...participatory approaches to engage in dialogue with communities in order to address cultural factors that affect use of care."
- The companion of choice at birth should ensure that women's voices are central.
- Community mobilisation through facilitated participatory learning and action cycles involves a four-phase participatory process run by a trained facilitator, in which women’s groups collectively decide priority actions and organise activities accordingly. Phase 1, identify and prioritize problems during pregnancy, childbirth and after birth; Phase 2, plan activities; Phase 3, implement activities to address the priority problems; and Phase 4, assess the activities with women’s groups.
- Community participation in quality improvement processes by jointly defining and assessing quality of programmes is recommended. Mechanisms that ensure women’s voices are meaningfully included are also recommended.
- Community participation in programme planning and implementation can be done by consultation, community membership on management committees, or meeting with the community, again with inclusion of women's voices.
Conditional recommendations (requiring further evidence) include:
- Maternity waiting homes (MWHs) near healthcare facilities can be of service in pregnancy, especially for remote populations where complications might arise.
- Community-organised transport schemes with care to ensure the sustainability, efficacy, and reliability of these community-based schemes while seeking long-term solutions to transport may be a measure that saves lives through organising available resources.
Research recommendations include:
- Interventions to promote awareness of human, sexual, and reproductive rights and the right to access quality skilled care for pregnant women and those with infants should "address ...family, the broader community, service providers, managers and other health systems stakeholders to increase awareness of the right to health and to access quality skilled care. Programmatic inputs include education materials or other visual aids, mass media campaigns and working with groups or public meetings and often focus on what should be improved to ensure quality services."
- Community participation in Maternal Death Surveillance and Response (MDSR) "includes routine identification and timely notification of maternal deaths, reviews of maternal deaths and implementation and monitoring of steps to prevent similar deaths in the future. Community participation in this process may help provide more accurate information on number of deaths, and where and why the women died. Community participation in analysing information and in identifying possible solutions may help address social determinants, meet community needs and incorporate a range of actors in the response."
WHO website, June 2 2015.