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The article discusses a study which assessed the effectiveness of community mobilisation through participatory women's groups to improve birth outcomes in poor rural communities in three districts in India. The researchers assigned 18 clusters to intervention or control using stratified randomisation from 36 clusters in Jharkhand and Orissa. Strategies were implemented to address maternal and newborn health problems. It was discovered that there were reductions in neonatal mortality rate and maternal depression scores.

A letter to the editor is presented in response to the article "Global, Regional, and National Causes of Child Mortality in 2008: A Systematic Analysis," by R. E. Black and colleagues, published in the June 5, 2010 issue.

Background Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. We assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings. Methods We did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. We also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries. Findings Seven trials (119 428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0.63, 95% CI 0.32-0.94), a 23% reduction in neonatal mortality (0.77, 0.65-0.90), and a 9% non-significant reduction in stillbirths (0.91, 0.79-1.03), with high heterogeneity for maternal (I²=58.8%, p=0.024) and neonatal results (I²=64.7%, p=0.009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0.026 and p=0.011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0.45, 0.17-0.73) and a 33% reduction in neonatal mortality (0.67, 0.59-0.74). The intervention was cost effective by WHO standards and could save an estimated 283 000 newborn infants and 41100 mothers per year if implemented in rural areas of 74 Countdown countries. Interpretation With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings. Funding Wellcome Trust, Ammalife, and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Birmingham and the Black Country programme. [ABSTRACT FROM AUTHOR]

This article discusses the role of community participation in medical care for mothers and their newborn children. The role of community participation in public health administration is framed as a goal established by the 1978 Alma-Ata, Kazakhstan Declaration on primary care in public health. Controversy regarding the relative importance of targeted interventions and community based health services in international aid to medical care is described. Community based efforts to develop public health interventions are framed in terms of their small scale compared to commodity based approaches that provide products such as mosquito netting and oral rehydration formula to treat diarrhoea. INSETS: Panel 1: Projects in rural India and Kenya which influenced...;Panel 2: Building community empowerment;Panel 3: Case study of how women's groups are addressing first....