Journal of Midwifery & Women’s Health www.jmwh.org Original Research The Effect of Community Maternal and Newborn Health Family Meetings on Type of Birth Attendant and Completeness of Maternal and Newborn Care Received During Birth and the Early Postnatal Period in Rural Ethiopia Danika Barry, MPH, ∗ Aynalem Hailemichael Frew, RN, RM, MPH, ∗ Hajira Mohammed, MSc, Binyam Fekadu Desta, MPH, Lelisse Tadesse, BSc, Yeshiwork Aklilu, RN, MPH, Abera Biadgo, MPH, Sandra Tebben Bufngton, CNM, PNP, MPH, Lynn M. Sibley, CNM, PhD, RN Introduction: Maternal and newborn deaths occur predominantly in low-resource settings. Community-based packages of evidence-based in- terventions and skilled birth attendance can reduce these deaths. The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) used community-level health workers to conduct prenatal Community Maternal and Newborn Health family meetings to build skills and care-seeking behaviors among pregnant women and family caregivers. Methods: Baseline and endline surveys provided data on a random sample of women with a birth in the prior year. An intention-to-treat analysis, plausible net effect calculation, and dose-response analysis examined increases in completeness of care (mean percentage of 17 maternal and newborn health care elements performed) over time and by meeting participation. Regression models assessed the relationship between meeting participation, completeness of care, and use of skilled providers or health extension workers for birth care—controlling for sociodemographic and health service utilization factors. Results: A 151% increase in care completeness occurred from baseline to endline. At endline, women who participated in 2 or more meetings had more complete care than women who participated in fewer than 2 meetings (89% vs 76% of care elements; P  .001). A positive dose-response relationship existed between the number of meetings attended and greater care completeness (P  .001). Women with any antenatal care were nearly 3 times more likely to have used a skilled provider or health extension worker for birth care. Women who had additionally attended 2 or more meetings with family members were over 5 times as likely to have used these providers, compared to women without antenatal care and who attended fewer than 2 meetings (odds ratio, 5.19; 95% confidence interval, 2.88-9.36; P  .001). Discussion: MaNHEP’s family meetings complemented routine antenatal care by engaging women and family caregivers in self-care and care- seeking, resulting in greater completeness of care and more highly skilled birth care. J Midwifery Womens Health 2014;59:S44–S54 c  2014 by the American College of Nurse-Midwives. Keywords: community-based intervention, Ethiopia, maternal and newborn health, participatory, skilled birth attendance INTRODUCTION The global burden of maternal and newborn mortality is borne almost exclusively by low- and middle-income countries. 1 Despite progress in the last decade, Millennium Development Goals 4 and 5, which address these issues, are unlikely to be met by the 2015 target in many countries. 2 In Ethiopia, a country with one of the world’s highest rates of ma- ternal and newborn mortality, the Federal Ministry of Health has undertaken aggressive steps to enact national policies de- signed to meet the Millennium Development Goals. It is well understood that a package of simple, low-tech practices—such as clean birth practices; neonatal resuscita- tion; and immediate, exclusive breastfeeding—can dramat- ically and positively improve newborn survival. 3 Evidence establishes that integrating such practices into community- based health care delivery systems is an effective means of service delivery. 4, 5 Likewise, there is strong evidence that be- ∗ These authors contributed equally to this work. Address correspondence to Danika Barry, MPH, 1520 Clifton Rd., Suite 261, Atlanta, GA 30322. E-mail: danika.barry@gmail.com havior change communication campaigns, 6 home visits, and participatory campaigns 7 can reduce delays in health care seeking, which are so detrimental to the well-being of mothers and newborns 8 and also promote facility births. 7, 9 Numerous governmental and nongovernmental spon- sored trials have demonstrated that community-based ap- proaches can and do save the lives of newborns, and early complication recognition and referral coordination for skilled care has been shown to save the lives of mothers. 10, 11 These efforts have entailed strategies such as home visits by health workers, 12, 13 training of traditional birth attendants (TBAs) and other community-level lay providers, 14–18 and the Warmi Project-derived efforts to organize women’s groups that aim to improve self-care practices and identify and remove barriers to safe birth. 19–23 Several projects have demonstrated success in using local women to create demand for use of evidence- based birth packages. 24–26 Other projects have demonstrated the importance of involving husbands and men in efforts to promote safe birth. 27, 28 The Maternal and Newborn Health in Ethiopia Partner- ship (MaNHEP) was a 3.5-year learning project supported by the Bill and Melinda Gates Foundation and operated S44 1526-9523/09/$36.00 doi:10.1111/jmwh.12171 c  2014 by the American College of Nurse-Midwives