1. MOTHERS AND MOTHER-IN-LAWS: assessing the effectiveness of interaction interventions at a community level CARE Nepal CRADLE CS Project

2. Introduction  In 2009, Nepal had a MMR of 229 per 100,000 live births  There are many intermediate causes of under utilization of maternal health services by women including the relationship with the MiL

3. Introduction  In Nepal, it is customary for MiL to exercise power and decision making over daughter in laws  They can play vital role in decision making, sharing of work load, managing food intake, making birth preparedness plans, and sharing control over resources

4. Introduction  One of the important activities under this dimension is the interaction of pregnant, recently delivered women and mother in laws  Pregnant women, recently delivered women and their mothers-in-law interact to discuss and learn about maternal and newborn health practices that can benefit newborns, as well as, ensure the health of the mother during pregnancy and post partum.

5. Objectives  The main objective of this study is to understand the effectiveness of interaction of PW/RDW/MiL among mothers with a child less than six months and their mother in laws in Kailali Specific Objectives:  To compare the knowledge on maternal and neonatal health among mothers of the intervention group and comparison group.  To compare the knowledge on maternal and neonatal health among mother in laws of the intervention group and comparison group.  To assess the maternal and neonatal health practices of mothers and their mother-in-laws.  To explore role of the mother in law during pregnancy and postnatal period.

6. Methods  a descriptive comparative study  Studied Mothers who had delivered baby within three months and their MiL  Kailali District  urban and rural areas where interaction was done within last 6 months by CRADLE  Structured interviews by Field Mobilizers with Mothers and MiLs

7. Knowledge of Mothers VariableIntervention (%) N=60 Comparison (%) N=60 ANC Check ups80.070.0 Birth Preparedness Plan95.086.7 Plan for Delivery91.568.3 Incentive98.069.0 Had delivery at HF69.053.3 Ate Nutritious Food during Pregnancy 61.743.3

8. Knowledge of Mothers

12. Knowledge of MiLs VariableIntervention (%) N=60 Comparison (%) N=60 ANC85.051.7 Basic Neonate Care68.335.6 Support Mother with Work After Delivery 74.665.0

13. Behavior of MiLs

14. Comparison Source of Information Comparison (%) N=60 Intervention (%) N=60 Interaction Meeting 0.081.7 Radio and TV 16.73.3 Mother’s Group 16.73.3 MiL1.7 FCHV61.70.0 Source of Information Comparison (%) N=60 Intervention (%) N=60 Interaction Meeting 0.080.0 Radio and TV 15.00.0 Mother’s Group 33.311.7 DiL15.00.0 Other36.78.3 MothersMother-in-Laws

15. Comparison  The presence of mother in laws and husband during ANC check up of mothers was higher by 16.0% and 10.0%, respectively, in the intervention group than the comparison group.  Among mothers who told that they had taken additional food during pregnancy, majority of them said the food was managed by their mother in laws

16. Conclusion  The difference in knowledge and practices of mothers and their mothers in laws among two study groups indicated that the interaction meeting had been much effective in upgrading knowledge and healthy behaviors regarding maternal and neonatal health care.  the supports of mothers in laws in managing nutritional food during pregnancy, deciding health facility for delivery, helping in work before and after delivery were seen significantly higher in the intervention group than comparison group.  Therefore, the interaction of pregnant women, recently delivered women with their mother in laws has been one of the effective and successful innovative activities of CRADLE support project in generating awareness at community level.