Aims Participatory postnatal women’s groups have been shown to have significant impact on maternal and neonatal mortality in low-income countries. It is not clear however whether this approach can be used to address maternal and child health issues in other settings, such as the UK. We carried out a systematic review to answer the question: ‘Can postnatal women’s groups (employing participatory and non-participatory approaches) improve health outcomes for mothers and children in high-income countries (HIC)?’
Methods We included randomised controlled trials testing any group-based intervention conducted in the postnatal period in HIC. Studies were included if they measured any health or social outcome in the mother or child. MEDLINE, EMBASE and the Cochrane database were searched.
Results Six trials fitted our criteria. The trials utilised diverse frameworks for intervention, investigating a total of 3,149 women. Studies were heterogeneous in key factors (population, intervention and outcomes). Three focused on single health outcomes – two on postnatal depression and one on physical activity (PA). The remainder examined broader or multiple health and social indicators such as health service use, depression and social support.
Cramp et al. showed a significantly higher change in frequency and volume of PA among participants receiving a cognitive behavioural therapy intervention compared with controls. The other trials reported no significant differences between trial arms, however, possibly due to difficulties in retention, loss to follow-up, underpowered sample sizes. A recurring concern among those conducting these trials of group support was intervention uptake and attendance. Reid et al. reported participation as low as 18%. A further concern was the higher proportion of women from ‘middle class’ than ‘working class’ backgrounds reporting attendance.
Conclusion There is limited evidence testing the use of postnatal group based interventions to improve health outcomes. Only 6 RCTs were identified and only one, examining physical activity, showed a positive effect, possibly due to difficulties in uptake, retention and underpowered samples. Further research should assess the use of lay support workers in community settings on group attendance and outcomes.
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