Improving Postpartum Best Practices for Mothers and Newborns in Rural Ecuador

The project was supported by the American people through the United States Agency for International Development (USAID) through its Child Survival and Health Grants Program. The EONC project was managed by the Center for Human Services under Cooperative Agreement No. GHS-A-00-09-00008-00. The project was implemented in 21 rural parishes in Cotopaxi, a mountainous region in the Ecuadorean Andes, approximately 130 kilometers south of Ecuador's capital, Quito. The province has a large rural population, with 67% of its 384,449 inhabitants living in rural areas. The population is predominantly poor, with 90% living below the poverty line, and has limited access to skilled maternal-newborn health care services. The 21 project parishes were deliberately selected as part of an equity strategy, with selection criteria including more than 40% Ecuadorian Indian and more than 50% extreme poverty. The EONC project aimed to improve the coverage and quality of early-postpartum services, enhance household knowledge, and increase the use of best practices. The project's main innovation was the introduction and implementation of a province-wide EONC network, which has three interacting levels: a parish-level "micro-network" that unites community and primary health care providers and representatives, a county-level network that coordinates community, primary, and hospital services at that level, and coordination of referral-level comprehensive obstetric and neonatal services in the provincial capital hospitals. The operations research (OR) intervention, implemented as part of the EONC project, combined early-postpartum service delivery (home and facility, including clinical care and counseling) and a social behavior change communication (SBCC) intervention. The service delivery and SBCC interventions were introduced in two phases in the 21 parishes. In the first phase (2009-2011), the OR intervention and other project interventions were implemented, including training for community health workers (CHWs) and traditional birth attendants (TBAs) on early-postpartum care and counseling. Key findings from the project include: * Postpartum/postnatal visits within the first 2 days of birth increased from 63% to 88%. * Facility deliveries using Active Management of Third Stage Labor (AMTSL) increased from 68% to 97%. * Newborns receiving postnatal care within 48 hours of birth increased from 52.5% to 81% in intervention parishes, nearly double the increase in the non-intervention group. The project's findings highlight the importance of early-postpartum best practices in reducing maternal and newborn mortality. The project's interventions, including the introduction of a province-wide EONC network and training for CHWs and TBAs, have improved the coverage and quality of early-postpartum services, enhanced household knowledge, and increased the use of best practices. The project's results demonstrate the potential for scaling up effective interventions to improve maternal and newborn health outcomes in rural Ecuador.