PROJECT
Safe Motherhood Applied Research and Training Project in Pakistan

The Safe Motherhood Applied Research and Training (SMART) project, funded by the European Union, was a three-year operations research project. The Population Council aimed to reduce maternal and neonatal mortality in D.G. Khan District, Punjab, and to provide comprehensive analysis of the results. Program components included increasing community awareness about obstetric and neonatal danger signs; increasing preparedness for emergency care, including transport; improving the quality and accessibility of basic and comprehensive emergency obstetric and neonatal care; and improving health care providers' interpersonal communication skills.

The research design involved three cells: health systems improvement (HSI) only, HSI plus community-based involvement (CBI), and a control (in Layyah District), each involving 60 rural communities chosen at random. A variety of quantitative and qualitative techniques were used to evaluate inputs, processes, outputs, and impact and to study in detail community and provider attitudes and responses regarding maternal and neonatal health. The project trained several hundred providers, from health managers and specialist physicians to paramedics in the HSI areas and, in addition, lady health workers and traditional birth attendants in the HSI plus CBI areas. In addition, in the HSI plus CBI areas a variety of community leaders were involved, and more than 33,000 women and men participated in support groups.

In an operational period of less than two years, substantial improvements were seen in the knowledge and practices of women, as well as the skills and practices of traditional birth attendants in the HSI plus CBI areas. The perinatal mortality rate (the main outcome variable defined in the proposal) declined by 22 percent in the HSI plus CBI area, a significant change (p=.017); no declines occurred in the HSI only or control areas. It appears that provider training activities were not sufficient in themselves to cause mortality decline, but the addition of a program of community-based involvement did result in mortality decline.

These results, including specific project innovations, are being used to strengthen maternal and neonatal health programs more widely in Pakistan.

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Location

D.G. Khan and Layyah Districts, Punjab, Pakistan

Duration

October 2002–October 2006

Population Council researchers

Peter C. Miller, Zeba A. Sathar, Gul Rashida, Zakir Hussain Shah, Abdul Wajid, Muhammad Shafique Arif, Ali Mohammad Mir

Donor

European Union

Publications/Resources
Council researchers' names appear in boldface type. 

2006
Arif, Muhammad Shafique, Peter C. Miller, Nayyer Munir, and Irfan Masood. "Safe Motherhood Applied Research and Training (SMART) Report 3: Changes in knowledge and behavior of women and families," Islamabad: Population Council. (PDF)

Rashida, Gul and Peter C. Miller. "Safe Motherhood Applied Research and Training (SMART) Report 1: Project overview," Islamabad: Population Council. (PDF)

Shah, Zakir Hussain and Saima Pervaiz. 2006. "Safe Motherhood Applied Research and Training (SMART) Report 4: Knowledge and behaviour of service providers." Islamabad: Population Council. (PDF)

Wajid, Abdul, Zakir H. Shah, Ashfa Hashmi, Zeba Tasneem, and Lubna Shireen. "Safe Motherhood Applied Research and Training (SMART) Report 2: The interventions," Islamabad: Population Council. (PDF)

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See Also

• Pakistan

• Safe Motherhood/Postpartum Care

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