Effectiveness of Women-centred Participatory Learning and Action Approach on Maternal and Newborn Healthcare Utilisation: a Quasi-experimental Embedded Implementation Research

Effectiveness of Women-centred Participatory Learning and Action Approach on Maternal and Newborn Healthcare Utilisation: a Quasi-experimental Embedded Implementation Research | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Women-centred Participatory Learning and Action Approach on Maternal and Newborn Healthcare Utilisation: a Quasi-experimental Embedded Implementation Research Agumasie Semahegn, Gizachew Tadele Tiruneh, Nebreed Fesseha, Mikiyas Teferi, and 24 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9247560/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Despite substantial progress in maternal and newborn health (MNH) over the past three decades, significant inequities persist in Ethiopia, particularly in agrarian and pastoralist communities where geographic, socio-economic, and gender-related barriers constrain access to essential MNH services. In response, a community-led, women-centered Participatory Learning and Action (PLA) model was designed and tested to enhance service uptake in hard-to-reach settings. This study assessed the effectiveness of the PLA-MNH intervention in improving MNH service utilisation across diverse livelihood contexts. Methods A community-based quasi-experimental study was implemented across five woredas using a mixed-method embedded implementation research design. Baseline (n = 1,581) and endline (n = 1,803) household surveys and 90 qualitative interviews were conducted using a two-stage cluster sampling approach covering 87 kebeles. The intervention was implemented through four PLA phases and eleven structured group meeting cycles, delivered by 242 PLA groups between July 2024 and June 2025. Human-centered design principles guided the development of PLA job aids. Quantitative data were analysed using Stata/SE 18.0 to compute Difference-in-Difference (DiD) using mixed-effects logistic regression to estimate net intervention effects, while qualitative data from in-depth and key informant interviews were analysed thematically. Results The women-centred PLA-MNH group reached over 96, 000 people. Across intervention sites, institutional delivery increased by 14.4 percentage points (36.3% to 50.7%), compared to a 4.0-point increase in comparison areas. Child vaccination coverage improved by 29.3 percentage points in intervention areas versus 7.4 points in comparison sites. ANC attendance increased significantly in pastoralist communities (DiD + 9.5, p < 0.001), while institutional delivery rose markedly in both agrarian (DiD + 28.9, p < 0.001) and pastoralist areas (DiD + 15.0, p < 0.001). Postnatal care within six weeks improved significantly in agrarian (DiD + 20.3, p = 0.001) and pastoralist settings (DiD + 13.6, p < 0.001). Qualitative findings revealed strong community trust, enhanced health knowledge, strengthened linkages with frontline providers, and increased community ownership. Conclusions The community-led, women-centered PLA-MNH intervention produced significant improvements in MNH service uptake across both agrarian and pastoralist contexts. The approach was feasible, trusted, and effectively integrated with existing community structures. By empowering women and engaging wider community members, the model strengthened local capacity, improved equity, and demonstrated strong potential as a scalable and sustainable strategy to advance MNH outcomes in underserved areas of Ethiopia. Participatory Learning and Action Women-centred maternal and newborn health Ethiopia Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 07 May, 2026 Reviews received at journal 29 Apr, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviewers invited by journal 24 Apr, 2026 Editor invited by journal 06 Apr, 2026 Editor assigned by journal 30 Mar, 2026 Submission checks completed at journal 30 Mar, 2026 First submitted to journal 27 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9247560","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634303425,"identity":"b7da2c54-002f-4488-99ef-2ad8df587682","order_by":0,"name":"Agumasie Semahegn","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYPACCWZ+EJVQQLwWG3bJBpAWA+K1pPEbHADRxGjh719juuHHn8PSxudXJ354YMAgzy92AL8WiRtvzG72th02NrvxdrME0GGGM2cnELDmxhmzG7wNh5PNbpzdANKSYHCbgBZ5oJabf/4crt884+zmH0RpMTjfY3abhy2N2YC/dxtxthjeYCu7Ldtmwyxxg3ebRYKBBGG/yJ0/vO3mmz/AqOw/u/nmjwobeX5pAloYJBJQGBIElIMA/wF0xigYBaNgFIwCNAAAgyZJhQaIzNwAAAAASUVORK5CYII=","orcid":"","institution":"Amref Health Africa in Ethiopia","correspondingAuthor":true,"prefix":"","firstName":"Agumasie","middleName":"","lastName":"Semahegn","suffix":""},{"id":634303426,"identity":"dbed34d0-0d17-4340-bcb4-afa24d366f18","order_by":1,"name":"Gizachew Tadele Tiruneh","email":"","orcid":"","institution":"JSI","correspondingAuthor":false,"prefix":"","firstName":"Gizachew","middleName":"Tadele","lastName":"Tiruneh","suffix":""},{"id":634303427,"identity":"88aa34da-dbdd-4f47-a2a6-9a06075bdbf7","order_by":2,"name":"Nebreed Fesseha","email":"","orcid":"","institution":"JSI","correspondingAuthor":false,"prefix":"","firstName":"Nebreed","middleName":"","lastName":"Fesseha","suffix":""},{"id":634303428,"identity":"e178238f-d6b1-4eaf-bcdb-6dfa27776a4f","order_by":3,"name":"Mikiyas Teferi","email":"","orcid":"","institution":"Amref Health Africa in Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Mikiyas","middleName":"","lastName":"Teferi","suffix":""},{"id":634303429,"identity":"823f5d7c-fcfc-470f-93e6-4046d606511f","order_by":4,"name":"Hillina Tadesse","email":"","orcid":"","institution":"JSI","correspondingAuthor":false,"prefix":"","firstName":"Hillina","middleName":"","lastName":"Tadesse","suffix":""},{"id":634303430,"identity":"674d7a51-b291-4ec9-91d5-79a0a701a781","order_by":5,"name":"Biruk Bogale","email":"","orcid":"","institution":"JSI","correspondingAuthor":false,"prefix":"","firstName":"Biruk","middleName":"","lastName":"Bogale","suffix":""},{"id":634303431,"identity":"4e51b958-d4b7-4f85-9529-df0978c1486c","order_by":6,"name":"Shegaw Mulu","email":"","orcid":"","institution":"Amref Health Africa in Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Shegaw","middleName":"","lastName":"Mulu","suffix":""},{"id":634303432,"identity":"042089b1-79b6-4c96-b911-3c7feed1ea89","order_by":7,"name":"Alemnesh Hailemariam Mirkuzie","email":"","orcid":"","institution":"JSI","correspondingAuthor":false,"prefix":"","firstName":"Alemnesh","middleName":"Hailemariam","lastName":"Mirkuzie","suffix":""},{"id":634303433,"identity":"64925b0b-5efd-4f72-8e3e-54200b5a4d83","order_by":8,"name":"Addis Girma","email":"","orcid":"","institution":"Amref Health Africa in Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Addis","middleName":"","lastName":"Girma","suffix":""},{"id":634303434,"identity":"d163a2ee-07d0-4c80-a9d3-7d4ec843c527","order_by":9,"name":"Chala Tesfaye","email":"","orcid":"","institution":"JSI","correspondingAuthor":false,"prefix":"","firstName":"Chala","middleName":"","lastName":"Tesfaye","suffix":""},{"id":634303435,"identity":"e08003fd-58b8-4826-b10d-ed16f53728d0","order_by":10,"name":"Mebrie Belete","email":"","orcid":"","institution":"Amref Health Africa in Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Mebrie","middleName":"","lastName":"Belete","suffix":""},{"id":634303439,"identity":"98f52579-1657-4b01-812f-972f81bf0a60","order_by":11,"name":"Biruhtesfa Bekele","email":"","orcid":"","institution":"JSI","correspondingAuthor":false,"prefix":"","firstName":"Biruhtesfa","middleName":"","lastName":"Bekele","suffix":""},{"id":634303442,"identity":"9ad3ac22-360f-4ac8-9ca9-c1b6b7407fa3","order_by":12,"name":"Yenegeta Walelign","email":"","orcid":"","institution":"Amref Health Africa in Ethiopia","correspondingAuthor":false,"prefix":"","firstName":"Yenegeta","middleName":"","lastName":"Walelign","suffix":""},{"id":634303443,"identity":"11ecfcad-b86d-4961-8cdb-8e0a667b4e81","order_by":13,"name":"Abdulhalik Workicho","email":"","orcid":"","institution":"Fenot project-Harvard T.H. 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Research","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Participatory Learning and Action, Women-centred, maternal and newborn health, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-9247560/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9247560/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDespite substantial progress in maternal and newborn health (MNH) over the past three decades, significant inequities persist in Ethiopia, particularly in agrarian and pastoralist communities where geographic, socio-economic, and gender-related barriers constrain access to essential MNH services. In response, a community-led, women-centered Participatory Learning and Action (PLA) model was designed and tested to enhance service uptake in hard-to-reach settings. This study assessed the effectiveness of the PLA-MNH intervention in improving MNH service utilisation across diverse livelihood contexts.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA community-based quasi-experimental study was implemented across five woredas using a mixed-method embedded implementation research design. Baseline (n\u0026thinsp;=\u0026thinsp;1,581) and endline (n\u0026thinsp;=\u0026thinsp;1,803) household surveys and 90 qualitative interviews were conducted using a two-stage cluster sampling approach covering 87 kebeles. The intervention was implemented through four PLA phases and eleven structured group meeting cycles, delivered by 242 PLA groups between July 2024 and June 2025. Human-centered design principles guided the development of PLA job aids. Quantitative data were analysed using Stata/SE 18.0 to compute Difference-in-Difference (DiD) using mixed-effects logistic regression to estimate net intervention effects, while qualitative data from in-depth and key informant interviews were analysed thematically.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe women-centred PLA-MNH group reached over 96, 000 people. Across intervention sites, institutional delivery increased by 14.4 percentage points (36.3% to 50.7%), compared to a 4.0-point increase in comparison areas. Child vaccination coverage improved by 29.3 percentage points in intervention areas versus 7.4 points in comparison sites. ANC attendance increased significantly in pastoralist communities (DiD\u0026thinsp;+\u0026thinsp;9.5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while institutional delivery rose markedly in both agrarian (DiD\u0026thinsp;+\u0026thinsp;28.9, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and pastoralist areas (DiD\u0026thinsp;+\u0026thinsp;15.0, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Postnatal care within six weeks improved significantly in agrarian (DiD\u0026thinsp;+\u0026thinsp;20.3, p\u0026thinsp;=\u0026thinsp;0.001) and pastoralist settings (DiD\u0026thinsp;+\u0026thinsp;13.6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Qualitative findings revealed strong community trust, enhanced health knowledge, strengthened linkages with frontline providers, and increased community ownership.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe community-led, women-centered PLA-MNH intervention produced significant improvements in MNH service uptake across both agrarian and pastoralist contexts. The approach was feasible, trusted, and effectively integrated with existing community structures. By empowering women and engaging wider community members, the model strengthened local capacity, improved equity, and demonstrated strong potential as a scalable and sustainable strategy to advance MNH outcomes in underserved areas of Ethiopia.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Women-centred Participatory Learning and Action Approach on Maternal and Newborn Healthcare Utilisation: a Quasi-experimental Embedded Implementation Research","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-05 15:49:38","doi":"10.21203/rs.3.rs-9247560/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"51628377059089146783987010610155780786","date":"2026-05-07T09:08:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T17:16:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128925464293136397066237226746250332350","date":"2026-04-27T17:44:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289957083148332834569804558585365917800","date":"2026-04-27T16:15:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-24T16:46:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-06T04:58:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-30T06:39:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-30T06:39:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-03-27T18:10:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"009a944c-bdb0-4d45-952c-740fc5dc4a69","owner":[],"postedDate":"May 5th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"51628377059089146783987010610155780786","date":"2026-05-07T09:08:36+00:00","index":67,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-29T17:16:44+00:00","index":54,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T15:49:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-05 15:49:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9247560","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9247560","identity":"rs-9247560","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}