Social networks improve maternal and newborn healthcare in urban slums

Women in urban slums who viewed community health workers as part of their social support network are more likely to adopt healthy maternal and child healthcare practices, says new icddr,b research

For millions of Bangladeshis, urbanisation offers an escape from rural poverty and a pathway to greater financial security, healthcare and livelihoods. But for some people, such as pregnant women, migration away from the home environment can bring vulnerability, isolation and a loss of the social support often present in rural family households. Many migrating men and women will find themselves in low income urban settlements, including slums, which are common targets for healthcare programmes – but how can this healthcare be best delivered and taken up?

icddr,b has recently discovered that social networks are powerful tools to help improve the healthcare delivered to women and their babies. In a new evaluation of BRAC’s Manoshi programme – established by the non-governmental organisation to deliver urban community based healthcare to mothers and their children in Dhaka – icddr,b’s Dr Alayne Adams and colleagues found that women are more likely to adopt positive maternal and child health practices when healthcare delivery utilises the power of social networks.

Women who saw their community health workers as important members of their social network were more likely to deliver their baby with a trained birth attendant, to give their baby nutrient-rich colostrum and to use postnatal care, compared to women who didn’t have community health workers within their social network.

Photo by DFAT Australian Aid, CC BY 2.0

The role of social networks emerged as icddr,b researchers began to examine what aspects of the Manoshi programme was responsible for its remarkable success. Manoshi had been established in 2007 building upon BRAC’s model of using Shasthya Shebikas (community health volunteers) in slums, which had first begun in 1998. Over 5 years, Manoshi has helped increase rates of facility delivery from 15 to 59% and the number of women receiving the recommended four or more antenatal care visits from 27 to 52%. Manoshi provides a unique well-supervised system of home-visiting and referrals to healthcare facilities, supported by community engagement through the use of women’s support groups and maternal and newborn health committees. The role of community health workers in creating social support  networks is known to be key.

Dr Adams, a senior social scientist in the Centre for Equity and Health Systems, and her colleagues Herfina Nababan and S. M. Manzoor Ahmed Hanifi interviewed 993 women in five urban slums in Dhaka City who had given birth within the last three months, asking them about their social ties. They found the influence of community  health workers to be striking:  women who viewed Manoshi health workers as important members of the social network were twice as likely to deliver with a trained birth attendant, 5 times more likely to use postnatal healthcare services and 3 times more likely to give nutrient-rich colostrum to their newborns. In contrast, women relying mostly on the support of mothers, mothers in-law or friends were less likely to access postnatal care or give colostrum to their newborn.

“When Manoshi health workers become part of a woman’s network, they provide expectant mothers with critical emotional, practical and informational support - connecting them with referral to maternity care, and supplying vital information on maternal and neonatal health best practices that is sometimes at odds with the traditional views and practices of friends and close family members like mother’s and mother’s in-law,” says Dr Adams.

Dr Kaosar Afsana, Director of BRAC’s Health, Nutrition and Population programme who initiated and led the Manoshi programme, appreciates the evidence showing the importance of social networks for the disadvantaged populations. She says “Research such as this is critical for understanding the strength of the community health worker model and social support networks. The relatively low-costs of investment in programmes like Manoshi have meaningful impact on the maternal and newborn experience of urban poor women, and should be taken into account while designing future urban maternal and neonatal health service delivery programmes, not only in Bangladesh, but beyond.”

The icddr,b evaluation was made possible through funding from the Bill & Melinda Gates Foundation to the BRAC Manoshi programme, and published in PLOS ONE