Context for layering women’s nutrition interventions on a large scale poverty alleviation program: Evidence from three eastern Indian states

Abstract

Over 70 million women of reproductive age are undernourished in India. Most poverty alleviation programs have not been systematically evaluated to assess impact on women’s empowerment and nutrition outcomes. National Rural Livelihoods Mission’s poverty alleviation and livelihoods generation initiative is an opportune platform to layer women’s nutrition interventions being tapped by project Swabhimaan in three eastern Indian states—Bihar, Chhattisgarh and Odisha. A cross-sectional baseline survey covering 8755 mothers of children under-two years of age, one of the three primary target groups of program are presented. Standardized questionnaire was administered and anthropometric measurements were undertaken from October 2016 to January 2017. 21 indicators on women’s empowerment, Body Mass Index and Mid-upper Arm Circumference for nutrition status, food insecurity indicators as per the Food Insecurity Experience Scale and selected indicators for assessing women’s access to basic health services were included. National Rural Livelihoods Mission operates in contexts with stark social and gender inequalities. Self-help group members exhibited better control on financial resources and participation in community activities than non-members. Using Body Mass Index, at least 45% mothers were undernourished irrespective of their enrolment in self-help groups. Higher proportion of self-help group members (77%-87%) belonged to food insecure households than non-members (66%-83%). Proportion of mothers reporting receipt of various components of antenatal care service package varied from over 90% for tetanus toxoid vaccination to less than 10% for height measurement. Current use of family planning methods was excruciatingly low (8.2%-32.4%) in all states but positively skewed towards self-help group members. Participation in monthly fixed day health camps was a concern in Bihar. Layering women’s nutrition interventions as stipulated under Swabhimaan may yield better results for women’s empowerment and nutrition status under National Rural Livelihoods Mission. While this opportunity exists in all three states, Bihar with a higher proportion of matured self-help groups offers more readiness for Swabhimaan implementation.

Community interventions with women’s groups to improve women’s and children’s health in India: a mixed-methods systematic review of effects, enablers and barriers

“… 41 45 51 63 66 Some researchers argued that the social cohesion of SHGs would make add-on health education interventions more effective. 12 74–79 Yet several empirical studies identified barriers to integrating health interventions into SHGs: limited priority and time for health, exclusion of the most vulnerable and instability of the ‘platform’ due to group dissolution and irregular meetings. 33 42 50 56 80–83 Finally, some studies argued that women’s groups could support health interventions through partnerships with government to monitor accountability as well as engage and mobilise communities, which appeared feasible in rural and urban settings.…”

“… 28 29 32 Observational studies reported limited coverage of young mothers in SHGs 100 101 : specific to RMNCH interventions, only one in four mothers with children under 2 years were SHG members in three states. 12 Stability of groups varied: 27% of original microfinance and health groups in rural Bihar dissolved over a 1-year study period 34 and open groups in Mumbai had 30% annual population turnover, 32 while rural, open groups and sex worker collectives sustained participation over longer intervention periods. 59 95 Lastly, intergenerational participation in groups was noted as important to address culturally rooted practices or household dynamics where mothers-in-law and family play an important role, such as birthing practices or domestic violence.…”

“…Capitalising on this coverage, the NRLM introduced health, sanitation and nutrition education into its SHG activities in 2017. 12 The second government initiative, led by the National Health Mission, incentivises around 1 million community health volunteers called Accredited Social Health Activists (ASHA), to facilitate regular meetings with women’s groups. Meetings are open to all and offer health-related interventions and linkages to public health services.…”

Antenatal Care Service Utilization Among Adolescent Pregnant Women–Evidence From Swabhimaan Programme in India

“…Ethical approval was taken from the Institutional Ethics Committee of All India Institute of Medical Sciences (AIIMS) of the respective states, namely, Bihar, Chhattisgarh, and Odisha. The impact evaluation was registered with the Registry for International Development Impact Evaluations (RIDIE-STUDY-ID-58261b2f46876) and the National Clinical Trials Registry of India with trial number CTRI/2016/11/007482 (33). Verbal consent was obtained from interviewed pregnant women.…”

Nutrition status of nulliparous married Indian women 15-24 years: Decadal trends, predictors and program implications

“…The recently launched Anemia Mukt Bharat (Anemia free India) includes adolescent girls, newlywed and young married women (20–24 years) as target beneficiaries which could be tapped for reaching out with a larger package of nutritional interventions of supplementation, counselling and treatment if needed [26]. Community models that reach out to newlywed women or couples and link income generation to nutrition are also available for testing feasibility of scale-up [46].…”