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Effect of Co-empowering Both Mother and Mother-in-Law on the Prenatal, Delivery, Postnatal Knowledge and Practices in the Far West Region of Nepal

Dipak P. Tiwari, Khagendra Bhatta, Noor Tirmizi, Nicky Roth, Nirmala Sharma, Ram Sharan Pyakurel, Deepak Paudel, Khrist Roy


This study compares prenatal, delivery, and postnatal knowledge and practices of daughter-in-law/mother-in-law (DIL/MIL) pairs who participated in an intervention meeting with those DIL/MIL pairs compared to where only DIL participated in the Female Community Health Volunteer (FCHV) meeting in Kailali district, far-west region of Nepal. The intervention was a 1−2 h meeting before the delivery with the DIL/MIL and the FCHV. The topics covered during the meeting were based on the Ministry of Health (MoH) Nepal’s existing programs on maternal, newborn, and child health including topics related to: antenatal care, skilled birth attendants, delivery at health facility, postnatal care, and newborn care including birth preparedness plans. A sample of 120 DILs, who had given birth in the past 3 months and their MILs were chosen from 10 randomly selected VDCs within the district of Kailali. Sixty DIL/MIL pairs (both also participated in the FCHV meeting) are defined as the intervention group and 60 DIL/MIL pairs (only DIL participated in the FCHV meeting) from the same VDCs, are defined as the comparison group. MIL/DIL pairs participated in the intervention meeting when DILs were at least 3 months pregnant; within 3 months of delivery the same pairs were interviewed. Following data collection, SPSS version 20 was used for analysis. Bivariate and multivariate logistic regression analyses were performed to understand the intervention effect.Majority of DILs in the intervention (41.0%) and comparison (55.0%) groups were between the ages of 20 and 24 years. Majority of MILs in the intervention group were 50 years of age or older and 32.0% were between the ages of 38 and 49 years. Over all, socio-demographics for both DILs and MILs in the intervention and comparison groups were largely similar. Regarding the service utilization practices, 69% of DILs in the intervention group had their delivery in a health facility, while 53.0% of DILs in the comparison group delivered their baby in health facility. A higher percentage of DILs in the intervention group attended a postnatal (61.0%) and neonatal (61.0%) checkup compared to the comparison group, 51.7 and 48.0%, respectively. Fifty percent of the mothers reported using family planning methods in the intervention group compared to only 36% in the comparison group after delivery to increase birth spacing. Multivariate analysis found that households where both DIL and MIL together participated, are more likely to have a birth preparedness plan (Odds Ratio (OR) = 5.4), better ANC knowledge (OR = 5.66), Neonatal knowledge (OR = 2.69) and are likely to practice the newly gained neonatal knowledge (OR = 3.87), compared to households where the MIL did not participate. DIL/MIL participation in the intervention shows greater positive effect across all MCH outcomes. Thus, co-empowerment as defined for the purposes of this study has the potential to greatly enhance the effect of MCH interventions on MCH outcomes and was shown to be an effective methodology for channeling greater MCH interventions effect.


Keywords: Mil/Dil Meeting, Birth Preparedness Plans and Co-Empowerment


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