Engaging Guatemalan Communities to Save Mothers

According to organisers, this programme was developed through community consultation and consideration of cultural context. Researchers began by identifying barriers preventing women from accessing pre- and post-natal care (e.g., lack of transportation, economic constraints, and fear of being mistreated at the facility). The team used interviews with community members and leaders as a tool for learning about family and community issues affecting pregnancy, childbirth, and postpartum periods. They also collected case histories of women who experienced obstetrical complications in one of the communities. With the help of local leaders and health personnel, the team then identified 100 communities to be included. Results from this formative research helped guide the design of an intervention that organisers claim considered both the cultural norms and barriers to accessing health care.

Improving and promoting the health care system was a key programme priority. The MOH developed a Performance and Quality Improvement (PQI) and accreditation model to improve the quality of care at health facilities for mothers. The programme team then designed the behaviour change and community mobilisation component to make sure women, their families, and communities were aware of the improved services and knew when and how to obtain them. Mass media was another tool for promoting improved health care services and encouraging people to use them.

In order to facilitate use of this improved system by those motivated to seek care, programme staff promoted family and community "emergency plans" (EPs) to prepare pregnant women, their families, and their communities to help make timely decisions to seek qualified medical care in the event of an obstetric or neonatal emergency. The plans detailed maternal danger signs and the necessary preparations for childbirth both at the family level (knowing where to go, how much money needs to be on hand, and who will take care of the house and the other children), as well as the community level (knowing who will accompany the woman, how she will be transported, and what economic assistance can be provided).

MOH staff and the programme team created a strategy to actively engage communities in preparing these EPs and to promote maternal and neonatal health. The team developed materials including individual EPs, posters for prenatal care, and handouts with pictorial descriptions of emergency signs and steps to seek care. The team also produced and broadcast a series of radio spots on maternal danger signs, community organisations who can assist mothers, and the importance of prenatal care. In addition, they published a manual to help communities develop a community-level EP. The MOH printed and disseminated the manual and other materials to health care facilities across the country.

Women, Health, Children.

In 2003, 80% of Guatemalan women received prenatal care during their last pregnancy. While the maternal mortality ratio in Guatemala fell from an estimated 219 maternal deaths per 100,000 live births in 1989 to 153 in 2000, it remains one of the highest in Latin America. The major causes of maternal mortality in Guatemala are preventable: hemorrhage (53%), followed by infection (14%) and hypertension (12%). In the western part of the country, between 69% and 80% of women deliver at home, where complications can lead to death if the family and community are not prepared.

According to programme monitoring data, by March 2004 in the 7 states included in the intervention, 99 communities had started the mobilisation process, 90 committees had been formed, and 44 pregnant women from 11 of these communities had been referred to a health care facility.