Health Partners International (HPI) implemented a community-based maternal and newborn health programme in Zambia, which resulted in positive changes in nutrition-related behaviour in six rural districts. The DFID-funded Mobilizing Access to Maternal Health Services in Zambia Programme (MAMaZ), implemented between 2010-2013, aimed to improve home-based care of pregnant women and increase their access to essential health services. Over the programme’s lifetime, men’s attitudes towards pregnant women began to change in intervention communities. They took more care to ensure that women had a balanced diet and did not over-exert themselves. The programme’s strategy of including men in community discussion groups and other awareness-raising activities helped to bring about these changes.
Inadequate nutrition is associated with the majority of maternal deaths in Zambia, whether directly or indirectly. Maternal anaemia, for instance, is linked to poor birth outcomes, pregnancy complications and death. Research conducted in Indonesia suggested a link between low calcium intake and pre-eclampsia, and that vitamin A and zinc deficiencies were related with sepsis and haemorrhage. Although these relationships are not fully understood, the provision of basic dietary advice is part of the standard package of care that should be offered to all pregnant women.
Baseline studies undertaken in the MAMaZ districts found knowledge of nutritional needs of pregnant women to be incomplete and, sometimes, misunderstood. Women’s health was also afforded a low priority against a backdrop of poverty, under-employment, food shortages and a range of other hardships faced by rural communities.
“….I have heard of women whose husbands wouldn’t respond to their desire for different food even if it was in their power to do so. Some husbands can’t respond – it’s just too hard for them. They can’t afford.” Female community member, Serenje District
Studies also found that pregnant women who were given dietary advice during antenatal care sessions were not always able to act on it if they were reliant on men to purchase food, or if older women in the household disapproved of them getting special treatment. MAMaZ’s response was to raise awareness on the need for special care during pregnancy, targeting the entire community so that women could begin to look after their health in an enabling environment without fear of disapproval.
A participatory community discussion group methodology was used to engage communities on a range of maternal and newborn health issues. In these sessions communities learned about protective foods such as bean or pumpkin leaves, sweet potato leaves, cassava leaves; body building foods such as beans, groundnuts, chicken, eggs, goat meat; and energy foods such as cassava, maize meal, millet, sorghum, and rice. The groups discussed how they could help pregnant women to have a balanced diet, particularly in situations where food was in short supply, and specific actions were agreed. For example, one community established a ‘safe motherhood garden’ that aimed to provide food on a sustainable basis for pregnant women. Other changes occurred at the household level, with many men making a commitment to supply the foods that women required.
“In the past I wasn’t allowing my wife to deliver in the health facility. I have now learnt from the Mama SMAGs [community health volunteers] that this is not safe. I have also learnt to save money and food whenever my wife is pregnant. This can make ‘things’ easy in case of difficulties during my wife’s pregnancy. We can have enough food as we wait for her to deliver at the health centre”.
The programme also encouraged District Health Management Teams to involve their nutritional staff in the provision of on-going mentoring and coaching support to communities. This helped to ensure that nutritional knowledge was sustained over time.
MAMaZ demonstrated that it is feasible to integrate a focus on maternal nutrition into a broad based community maternal and newborn health programme, at a low cost. The MAMaZ community engagement approach is currently being scaled-up at district and national level by a successor programme, MORE MAMaZ, with the financial support of Comic Relief. This new programme will help to ensure that more rural communities have access to basic nutritional information and are supported to use this, leading to improved health outcomes for pregnant women and newborns.
For more information contact Cathy Green at email@example.com
 Reported in The Safe Motherhood Action Agenda: Priorities for the Next Decade, 1998, Family Care International and Inter-Agency Group on Safe Motherhood.