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Pregnant Women’s Groups (PWGs): Connecting Women, Connecting to Good Health

By Israel Abebe
Pregnant Women's Groups in Nepal

At a recent meeting of pregnant women in Makwanpur district, Nepal, I saw firsthand how community volunteers could impact the lives of expectant women and their families. The meeting, more formally known as a Pregnant Women’s Group (PWG) session, was part of a structured approach that Plan uses to contribute to the reduction of maternal, perinatal, and child morbidities and mortality in Nepal.

Plan first used the PWG approach in 2003 and is currently implementing a USAID-funded maternal health project called the PWG project in Nepal. PWGs – peer-support groups of 8-15 pregnant women who live in the same ward –meet on a monthly basis. Meetings typically include interactive educational sessions, self-monitoring of service uptake, and pledging of commitment facilitated by female community health volunteers (FCHVs), who are part of the Nepal health system. FCHVs receive rigorous training on facilitation skills, health and WASH topics, and data recording. The technical topics of the FCHV training include danger signs during pregnancy, delivery, and after delivery; birth preparedness; nutrition; immunization; water, sanitation, and hygiene; and data recording. In addition to facilitating educational sessions on such topics, FCHVs are the frontline data collectors for PWGs. They use registers to keep records on attendance and activities completed, among other information. PWG meetings could also include sessions on how to advocate with local health providers for quality and accessible services. In addition, PWGs are used as a space for engaging men and relatives of the group members (e.g. spouses/partners, in-laws, and other family members) in maternal and child health. At the end of each PWG meeting, FCHVs solicit commitment from group members, as well as their attending family members, to apply what they learned. As such, the PWG approach seeks not only to empower pregnant women with information and knowledge, but also to address social and cultural barriers to services by building a community support system where positive peer pressure fosters lasting behavior change.

The PWG session I attended was held at a health post in Bhaise village development committee (VDC) that was built with support from Plan Nepal. The day of the visit marked the last day of a government-sponsored MMR (measles, mumps, rubella) campaign that was held at the health post, and the place was crowded with women and children. To the side, a group of pregnant women and their children, along with a FCHV, gathered for a PWG session. The session started with the group members updating the “social map” – a hand-drawn map of key service posts and the homes of the group members. Each member used different colored “tika” (each color representing a health service) and placed the “tika” near their home if they had used that specific service in the past month. This exercise allowed the PWG members to reflect on the types and number of maternal health services they’ve accessed.

The FCHV used the self-reported information to lead into a discussion on the topic of the day, which was danger signs during pregnancy. As a first time observer of a PWG session, it was exciting to see how the FCHV kept each of the group members engaged throughout. They posed questions to her and to one another, and shared experiences as they went.

After the session concluded, our chat with the PWG members revealed to us how much they appreciated interacting with one another. They value not only the health information they access but also the opportunity to interact with other pregnant women. One member told us she attended PWG meetings when she was pregnant with her younger child, and she’s now attending throughout her current pregnancy as well because she sees the PWG as a support group.

A district health office (DHO) program coordinator, who also attended the session, expressed that the PWG approach has proved a success in transforming Bhaise into a model VDC with significant improvements in ANC and PNC visits and facility delivery. While praising the PWG approach, the group members, the FCHV, and DHO official also shared with us some challenges and concerns. FCHVs are community volunteers who also offer their time to facilitate Mother Groups for no pay. While the government does provide FCHVs with items such as clothing, the FCHV asked what more could be done to keep the volunteers motivated and ensure that the volunteer system sustains. The FCHV also brought up the importance of uniformity of FCHV trainings and planning for refresher trainings as needed.

All the issues that were raised were very important and could impact maternal and child health outcomes. While, overall, southern Asia has seen its maternal mortality ratio fall by 64% between 1990 and 2013, there are women who still don’t have access to health information and services,  deliver without the attendance of skilled health personnel, and face the risk of dying from preventable complications during pregnancy, childbirth, or postpartum. Lack of awareness; gender, social, cultural, geographical, or financial barriers; and unavailability of information and services still persist in hard-to-reach and disadvantaged areas. With Plan’s longstanding presence and partnerships in Nepal and funding received from Development Innovation Ventures/USAID, Plan is currently working with various stakeholders to ensure the effectiveness and sustainability of PWGs and the use of evidence to inform the process of scaling up the PWG approach for a lasting impact on health outcomes.  

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