Community mobilization for prevention and treatment of obstetric fistula in Eritrea

This intervention study was conducted in rural Eritrea by the Eritrean Ministry of Health, in partnership with UNFPA and Stanford University. The aim of the intervention was to promote community knowledge, attitudes, and practices for safe motherhood, and thus contribute to the prevention of obstetric fistula and other birth complications. The strategy included training of Maternal Health Volunteers to lead participatory sessions with community members on safe motherhood, as well as training of health workers in interpersonal communication. Evaluation was conducted using a quasi-experimental study design. Baseline and final assessments in intervention and control areas included cross-sectional surveys of women who had given birth in the past 12 months (baseline N=466, final N=378), as well as focus groups. Health facility statistics showed increases in use of antenatal care (ANC) and health facility delivery in the intervention area. Although data from the control area indicates that there were improvements in safe motherhood knowledge in other parts of Eritrea as well during this period, there were larger positive effects in the intervention area. Behavior change in the intervention area was greatest in use of ANC services, whereas these behaviors remained unchanged in the control area. Findings also indicate that the quality of maternity care improved in the intervention area, but not in the control area. Alongside urgently needed improvements in transportation and access to emergency obstetric care, it appears that this type of community effort can make a contribution to improving maternal and infant health in this and similar remote rural settings.