India witnesses the largest number of maternal deaths in any single country, and within India, Rajasthan has among the highest maternal death rates. The early postpartum period has been recognized to be a time of heightened risk for both mother and newborn. While significant progress has occurred in developing community based approaches for promoting neonatal health, similar attention has not been paid to improving maternal health during the postpartum period.

Project Objectives:

1. To reduce maternal and neonatal mortality and morbidity in field area by providing an integrated care for mother and newborn in postpartum period to all women and newborns irrespective of place of delivery.
2. To carry out evidence based advocacy for maternal — neonatal health (including safe abortion) in a decentralized manner across the seven divisions of Rajasthan state, using a gender, rights and health systems approach.

• Registration of all pregnant women within the ARTH field area through village-based workers or volunteers and motivate them to seek at least four antenatal check-ups and deliver in an institution
• All pregnant women receive at least one ANC at ARTH, during which morbidities are identified, managed and recorded.
• VHWs and other key informants report all the deliveries, irrespective of place of delivery, preferably within three days of birth
• Two home based post natal visits made by nurse midwives and, subsequently, 3 visits between 14 to 28 days  by VHWs/ ASHAs in order to provide PNC according to a prescribed format
• Doctors and nurse midwives who attend to newborns/infants enquire about maternal morbidity and while attending to mother’s concerns, enquire about the infant’s health.
• In order to create demand of postpartum care from the family itself, educational – communication interventions actioned through pamphlets, video shows, wall paintings etc.

Qualitative research on maternal morbidity conditions has been going on as a part of the process to assess the burden and consequences of maternal morbidity in rural Rajasthan.

Progress/Outcomes:

The initial results of the study shed light on the terminology used by women to describe their postpartum morbidities and proved useful to further develop communication messages. It also showed that some life threatening morbidities continue to affect women beyond the 42 day period, in the first year after childbirth and hence the significance to provide care for one year after delivery.

The study was extended twice beyond it’s initial 3 years (2006-2009) in order to include further intervention time (2009-2010) as well as to complete an endline survey (2010-2011) and data analysis. Certain elements of the intervention that showed positive outcomes for both mothers and children continue to be adopted in an effort to support maternal and infant health and well-being.