Catherine Sikorski and Sietske Van Hees were joint first authors.
Introduction Participatory postnatal women’s groups have been shown to have a significant impact on maternal and neonatal mortality in low-income countries. However, it is not clear whether this approach can be translated to high-income countries (HICs). We conducted a systematic review to answer the question: “Can postnatal women’s groups improve health outcomes for mothers and children in high-income countries?” Methods MEDLINE, EMBASE and Cochrane databases were searched for randomised controlled trials testing any group-based intervention during the postnatal period, in HICs. No limitations were applied to stated outcomes. Results Nine trials, including 3029 women, fulfilled the criteria. Group-based interventions, facilitated by health professionals, ranged from didactic to participant-led. Three trials addressed postnatal depression, one addressed physical activity, whilst the remainder looked at multiple health or social outcomes. Three trials reported a significant association between their intervention and at least one outcome measure. Study limitations included poor and inequitable intervention uptake, low participant retention, small sample size and incomplete intervention description. Discussion This review found limited and incompletely described evidence testing the use of postnatal group-based interventions to improve health outcomes in HICs. Promising results were reported when the obstacles of sample size and group attendance were overcome. Studies reporting positive impacts on primary outcomes reported higher attendance rates and involved a psychoeducational or cognitive behavioural component in their group approaches. Further research should design and evaluate implementation strategies, assess the use of lay support workers in community settings to improve attendance and retention, and examine the effect of the group environment on outcomes.
Bryanton, J., Beck, C. T., & Montelpare, W. (2013). Postnatal parental education for optimizing infant general health and parent–infant relationships. The Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004068.pub4.
CASP. (2018). Critical Appraisal Skills Programme: CASP systematic review checklist online. http://www.casp-uk.net/.
Fu, I. C., Fong, D. Y., Heys, M., Lee, I. L., Sham, A., & Tarrant, M. (2014). Professional breastfeeding support for first-time mothers: A multicentre cluster randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology, 121(13), 1673–1683. CrossRef
Hagan, R., Evans, S. F., & Pope, S. (2004). Preventing postnatal depression in mothers of very preterm infants: A randomised controlled trial. BJOG: an International Journal of Obstetrics and Gynaecology, 111, 641–647. CrossRef
Muñoz, R. F., Le, H. N., Ippen, C. G., Diaz, M. A., Urizar, G. G. Jr., Soto, J., et al. (2007). Prevention of postpartum depression in low-income women: Development of the Mamás y Bebés/Mothers and Babies Course. Cognitive and Behavioral Practice, 14, 70–83. CrossRef
Prost, A., Colbourn, T., Seward, N., Azad, K., Coomarasamy, A., Copas, A., et al. (2013). Women’s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: A systematic review and meta-analysis. Lancet, 381(9879), 1736–1746. CrossRefPubMedPubMedCentral
Rath, S., Nair, N., Tripathy, P. K., Barnett, S., Rath, S., Mahapatra, R., et al. (2010). Explaining the impact of a women’s group led community mobilisation intervention on maternal and newborn health outcomes: The Ekjut trial process evaluation. BMC International Health and Human Rights, 10, 25. CrossRefPubMedPubMedCentral
Reid, M., Glazener, C., Murray, G. D., & Taylor, G. S. (2002). A two-centred pragmatic randomised controlled trial of two interventions of postnatal support. BJOG: An International Journal of Obstetrics and Gynaecology, 109, 1164–1170. CrossRef
Richardson, W. S., Wilson, M. C., Nishikawa, J., & Hayward, R. S. (1995). The well-built clinical question: A key to evidence-based decisions. ACP Journal Club, 123(3), A12–A13. PubMed
Rouhe, H., Salmela-Aro, K., Toivanen, R., Tokola, M., Halmesmäki, E., & Saisto, T. (2015). Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance. ACTA Obstetricia et Gynecologica Scandinavica, 94, 527–533. CrossRefPubMed
Shaw, E., Levitt, C., Wong, S., Kaczorowski, J., & McMaster University Postpartum Research G (2006). Systematic review of the literature on postpartum care: Effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. Birth, 33(3), 210–220. CrossRefPubMed
SIGN. (undated). Search filters: Scottish Intercollegiate Guidelines Network (SIGN). http://www.sign.ac.uk/methodology/filters.html.
Tripathy, P., Nair, N., Sinha, R., Rath, S., Gope, R. K., Rath, S., et al. (2016). Effect of participatory women’s groups facilitated by Accredited Social Health Activists on birth outcomes in rural Eastern India: A cluster-randomised controlled trial. The Lancet Global Health, 4(2), e119–e128. CrossRefPubMed
Wiggins, M., Oakley, A., Roberts, I., Turner, H., Rajan, L., Austerberry, H., et al. (2004). The social support and family health study: A randomised controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner-city areas. Health Technology Assessment, 8(32), iii. CrossRefPubMed
Younes, L., Houweling, T. A., Azad, K., Kuddus, A., Shaha, S., Haq, B., et al. (2015). The effect of participatory women’s groups on infant feeding and child health knowledge, behaviour and outcomes in rural Bangladesh: A controlled before-and-after study. Journal of Epidemiology and Community Health, 69(4), 374–381. CrossRefPubMed
- Could Postnatal Women’s Groups Be Used to Improve Outcomes for Mothers and Children in High-Income Countries? A Systematic Review
Sietske Van Hees
- Springer US
Maternal and Child Health Journal
Print ISSN: 1092-7875
Elektronische ISSN: 1573-6628