1. CORE GROUP FALL MEETING 2013
Prevention of Pre-term Birth
Community Approaches
to Underutilized and
Evidence-based Interventions
Carolyn Kruger, Ph.D.
Sr. Advisor MNCH, PCI

2. Evidence-based PTB/LBW Interventions
Use of antenatal corticosteroids (ACS) for pre-term
birth
Use of appropriate drug regimens for premature
rupture of membranes and infectious diseases (STIs,
malaria, newborn infections)
Resuscitation methods to help
babies breathe
Kangaroo Mother Care for
LBW babies
Chorhexidine – cord care

3. Additional Interventions
Evidence-based –applied at community level
Comprehensive Antenatal Care
– early and regular visits
Maternal nutrition and weight
gain
Birth preparation and early
recognition of complications
Clean/Skilled care delivery
Essential newborn care
Home-based Life Saving Skills
and HBB
© 2011 Save the
Children. All Rights
Reserved

4. Interventions Applied at Community Level
Prevention of infection – especially for PTB
Domestic violence- global violence- stress
Mental Health- assessment of depression
Pregnancy spacing and family planning

5. Community Strategies: Newborn
 Utilize existing platforms ( vulnerable
groups, HIV, MCH maternal and newborn,
child health) and integrate PTB evidencedbased interventions
 Strengthen access, quality and equity
of health services through community
advocacy- tracking vulnerable groups
 Build capacity of health services
in emergency care, Helping Babies
to Breathe and PTB

6. Community Strategies: Newborn/PPTB
Ensure Essential Commodities-
advocacy by community health committees
Build community leadership (tribal,
religious, community/civil committees) and
capacity to prevent PTBs
Overcome bottlenecks ( distance, referral
systems, poverty)

7. Promising Practices
Mother/Father Care Groups and home
visits to promote early ANC, birth
preparation, recognition of
complications and skilled care delivery
© UNICEF/NYHQ20102330/
Olivier Asselin, Mali, 2010
Bangladesh “Trio” Care Groups-Mother, Father and Grandmother influence
behavior change
-Fathers commit to providing food for
malnourished mothers and children
-Grandmothers commit to caretaking children
so that mother can “rest”

8. Trio Care Groups
PROSHAR TRIO CARE GROUP APPROACH
Each supervisor
oversees
approximately three
paid promoters
Each paid promoter
oversees
approximately 10
Care Group Trios
(4 supervisors total)
Each Care Group Trio consists of 12 leaders each. Mother CGs meet
monthly. Grandmothers & Father CGs will meet every three months with the
mother CGs.
(12 promoters total)
Promoter
Supervisor
(162 Care Group Trios total)
Grand
mothers
Mothers
Fathers
Promoter
Promoter
Each leader will meet with approximately 14 peers regularly
(monthly/mothers & quarterly/fathers & grandmothers) reaching
81,648 HH decision-makers

9. Trios Care Groups
BEHAVIOR CHANGE TRENDS
100
88.7
90
80
73
70
56
60
50
40
30
31.4
53
38.2
32.3
34.6
40.9
29.2
20
10
0
Exclusive Breast Early Initiation
Feeding
of BF
Baseline
3+ ANC Visits Post Partum Vit- 3 Correct IYCF
A
Behaviors
Sept 2012 Results

10. Promising Practices
 Adolescent and mother-friendly reproductive health services-
youth corners and teaching centers
 School and community advocacy for prevention of early marriage
and pregnancy- PTAs, teacher training, youth groups
 Community referral/ transportation systems- community
planned and owned
 Respectful maternity care- cultural sensitivity, equity support
 Economic and social empowerment groups- mothers group that
include a micro-credit component that increased their sense of
decision-making and household resources; WE groups –
Women’s Empowerment groups
 Feeding support- extra support for PTB

11. Promising Practices
Kangaroo Mother Care – health facility and community
outreach
Maternal Waiting Homes for high-risk pregnant women
Social shifting to prevent early
marriage
Promotion of girls’ and women’s
education
Community Health Committees that
advocate for essential commodities at
primary health clinics

12. Overcome Bottlenecks
Formative research- Barrier Analysis/doer-non-doer
Promote culture of respectful and equitable care
Knowledge sharing among community leaders –
champions
Inter-family dialogues
Utilize community leaders to
advocate for improved care
Community ownership
of the problem and
solution
Photo property of CARE, Nov 2011

13. DISCUSSION
Are you integrating prevention of PTBs? If so, HOW?
What is working? And if so WHY?
What are the barriers to integration?
What are the facilitating factors to integration?
Community ownership- ideas?
Are you aware of Newborn/PTB opportunities and
resources to share?
Have you visited your representative lately?