Effects of health behavior change intervention through women’s self-help groups on maternal and newborn health practices and related inequalities in rural India: A quasi-experimental study
In India, women from most marginalized populations disproportionately benefit from women’s self-help groups receiving maternal and newborn health behavior change communication interventions.
High rates of maternal and infant mortality in India remain a matter of concern, despite substantial improvement in recent years. The question persists of what can be done to improve maternal and newborn health (MNH) outcomes among low-income populations where high mortality and morbidity rates remain relatively high.
Women’s self-help groups (SHG), which consist of 10-15 women who convene for periodic meetings to share life experiences and discuss personal goals, may be a promising tool through which MNH information can be disseminated and subsequently improve outcomes among marginalized populations. However, there is limited evidence of the effectiveness of SHGs in improving women’s health, particularly in reducing health inequalities.
The authors conducted a quasi-experimental study of a large-scale SHG program in Uttar Pradesh, India. They evaluated the effects of health behavior change communication (BCC) interventions in women’s microfinance SHGs in a treatment population, and compared it with the outcomes of a control group that also participated in microfinance SHGs but did not receive the health BCC intervention. Data were obtained from surveys of both groups in 2015 and 2017.
Net improvements in health behavior change ranged from 5 to 11 percentage points across six maternal and newborn health outcomes and were strongest for families in the SHGs that received the health intervention (treatment group) as compared to SHG families who did not receive the health BCC intervention (control group). The improvements over time were higher among the most-marginalized populations.
For women in the treatment group versus women in the control group:
- There was a 5 percentage point increase in the proportion of women doing at least four antenatal care visits, and an 8 percentage point increase in the proportion of women doing three tests or examinations during pregnancy.
- There was a 5 percentage point increase in the proportion of women doing a postnatal care checkup within a week of delivery, and an 11 percentage point increase in the proportion of women currently using any contraceptive method.
- There was a 7 percentage point increase in the proportion of women who used clean cord care and a 6 percentage point increase in the proportion of women who initiated breastfeeding within an hour of delivery.
- Overall the Improvements in maternal and newborn health practices were statistically significant and higher among the most marginalized women, specifically for antenatal care visits (20 percentage points increase vs 6 pp for least marginalized women), consumption of iron-folic acid tablets (7 pp increase vs -1 pp increase for least marginalized women), current use of contraceptive methods (12pp vs 10pp), clean cord care (12pp vs 7pp), and timely initiation of breastfeeding (29pp vs 1pp).
The findings from this study indicate that discussions of key maternal and newborn health practices in SHG meetings, along with community outreach activities, can increase access to and help women follow select correct health care practices.
This study was an evaluation of a health BCC intervention using pre-existing micro-finance based SHGs. These groups were formed and managed by Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP) in Uttar Pradesh, India, serving approximately 1.7 million poor women across 49 districts of the state.
RGMVP’s micro-finance activities are organized into three-tiers. The first tier of SHGs is organized at the village level. The second tier are village organizations representing 150 to 250 women from 10 to 20 SHGs. Third are block organizations of 5,000 to 7,000 women. Each SHG meets weekly to discuss microfinance and livelihood issues and maintains a register.
The intervention block consisted of participants of microfinance SHGs who received a health behavior change intervention, while the control block consisted of participants of microfinance SHGs who did not receive the health intervention.
The primary intervention included maternal and child health information disseminated by trained peer educators in each SHG meetings, as well as building community norms for behavior change through a set of community outreach activities including home visits, community meetings, and community events such as Godhbharai (a ceremony to celebrate pregnancy) and Annaprasan Diwas (a ceremony for a child of six to eight months to initiate complementary food and breast feeding practices). These events were actively facilitated and arranged by village organizations and deployed audiovisual materials such as health videos to aid in intervention delivery.
In both rounds of data collection (2015 and 2017), all participants were women who were currently married, aged 15–49 years, and who had given birth in the 12 months prior to the survey. The study used data from 4,615 women who were interviewed in 2015, of which 4,250 were interviewed again in 2017. These women were sampled from 57 randomly selected blocks in 20 districts.
The primary outcomes measured in the study were:
- Reproductive and maternal health practices: At least four antenatal care visits; at least three antenatal care check-ups; consumption of 100 or more iron folic acid tablets; delivery in an institutional setting; postnatal care check-up within first seven days of delivery; and current use of any contraceptive method.
- Newborn health care practices: Clean cord care to prevent cord infection; skin-to-skin care to keep the newborn warm; timely initiation of breastfeeding; and exclusive breastfeeding.