Muslim religious scholars impact maternal and newborn health in Pakistan

Background: Current trends indicate that despite improvements over past 20 years, Pakistan still falls short of millennium development goals for maternal and infant health. Pakistan's maternal mortality ratio (276 per 100,000) and infant mortality rate (78 per 1,000) are among the world's highest (Pakistan Demographic Health Survey, 2006-2007).

Methods: As part of a larger ecologically based project, an intervention was designed to collaborate with influential Muslim religious scholars (Ulama) to sensitize them on maternal, neonatal and child health (MNCH) issues and engage them in improving community level MNCH. The intervention used Ulama led Friday sermons to reach male congregations. Over the course of one year, 400 Ulama were sensitized, in security-challenged areas with limited access to other information sources.

Evaluators randomly selected and assigned 51 mosques to intervention or comparison groups. A mixed methods evaluation including direct observations, in depth interviews, focus groups and exit interviews examined the intervention's effectiveness.

Results: Ulama participation was high. Exit interviews with 1,167 men (mean age: 40 years) found men exposed to messages had significantly higher knowledge and more positive attitudes compared with men unexposed: antenatal care (91 vs. 66%), birth preparedness (93 vs. 88%), transport planning (61 vs. 41%), saving money (75 vs. 49%), and delayed newborn bathing (41 vs. 28%).

Conclusions: The program provided a platform for community level collaboration and demonstrated the effectiveness of engaging religious leaders, and leveraging religious sermons as a forum to reach men, key decision-makers, to improve the lives of mothers and newborns in Pakistan.