Effect of health intervention integration within women's self-help groups on collectivization and healthy practices around reproductive, maternal, neonatal and child health in rural India

Abstract

BackgroundThis study evaluates an eight-session behavior change health intervention with women’s self-help groups (SHGs) aimed to promote healthy maternal and newborn practices among the more socially and economically marginalized groups.MethodsUsing a pre-post quasi-experimental design, a total of 545 SHGs were divided into two groups: a control group, which received the usual microcredit intervention; and an intervention group, which received additional participatory training around maternal, neonatal, and child health issues. Women members of SHGs who had a live birth in the 12 months preceding the survey were surveyed on demographics, practices around maternal, neonatal and child health (MNCH), and collectivization. Outcome effects were assessed using difference-in-difference (DID) methods.ResultsWomen from the SHGs with health intervention, relative to controls over time (time 1 to time 2), were more likely to: use contraceptive methods (DID: 9 percentage points [pp], p<0.001), have institutional delivery (DID: 9pp, p<0.05), practice skin-to-skin care (DID: 17pp, p<0.05), delay bathing for 3 or more days (DID: 19pp, p<0.001), initiate timely breastfeeding (DID: 21pp, p<0.001), exclusively breastfeed the child (DID: 27pp, p<0.001), and provide age-appropriate immunization (DID: 9pp, p<0.001). Additionally, women from the SHGs with health intervention when compared to the control group over time were more likely to report: collective efficacy (DID: 17pp, p<0.001), support through accompanying SHG members for antenatal care (DID: 8pp, p<0.05), receive a visit from SHG member within 2 days post-delivery (DID: 32pp, p<0.001), and receive reproductive, maternal, neonatal and child health information from an SHG member (DID: 45pp, p<0.001).ConclusionFindings demonstrate that structured participatory communication on MNCH with women’s groups improve positive health practices. In addition, SHGs can reach a substantial proportion of women while providing an avenue for pregnant women and young mothers to be assisted by others in learning and practicing healthy behaviors, thus building social cohesion on health.

Effects of health behaviour change intervention through women's self-help groups on maternal and newborn health practices and related inequalities in rural india: A quasi-experimental study

“…Consistent with findings from studies of similar interventions in other parts of the country [ 20 , 31 ], this study shows significant improvements in health practices in the intervention areas, particularly practices that are one-time point and independent of health care service supplies. In the comparison areas, some maternal and newborn practices also improved, which could be attributed to increased social cohesion and group collectivisation identified in other studies [20] . The results of this study as well as literature reveal that in less developed Indian states, women's exposure to mass media remains low [37][38][39][40] .…”

“…The concentration indices were computed and Lorenz curves were drawn for maternal health outcomes-ANC visits, check-ups, consumption of IFA tablets, institutional delivery, PNC check-ups and use of contraceptive method-dependent upon supply of services or access to health facilities. Lorenz curves were not drawn for newborn health outcomes-cord care, thermal care and breastfeeding practices-dependent on women's learning and practices, and less dependent on supply side factors [20] . All analyses employed Stata version 13 • 0 (StataCorp, College Station, TX, USA).…”

The Knowledge of Danger Signs of Obstetric Complications Among Women in Rural India: Evaluating an Integrated Microfinance and Health Literacy Program

“…Studies highlighted the positive effect of health literacy on improving maternal health utilisation despite low levels of education in communities (31). Community health programs are increasingly providing evidence for reducing maternal and newborn health inequities in rural areas through women's empowerment and support greater female economic participation (32)(33)(34). Additionally, community mobilisation advocates progressively push for layering multiple interventions, including nancial mechanisms in developmental packages for low resource regions seeking to impact maternal mortality (35)(36)(37).…”

“…The commonly adopted Roger's model of diffusion has been used in public health programs to describe the pattern of behaviour change adoption across communities using selected interventions such as contraceptive use, child marriage and intimate partner violence (47)(48)(49)(50). Moreover, while previous diffusion studies have shown the key role of interpersonal connection in promoting health information, the application of the model to evaluate the spread of micro nance has not yet been done (32,39,44,50). Particularly, no study elsewhere, to the best of our knowledge, has evaluated the diffusion of the knowledge of maternal danger signs from micro nance members to non-members in a rural setting with low literacy and high poverty-populations.…”

“…The IMFHL program provided health literacy to women on recognising key pregnancy-related danger signs, and adoption of birth preparedness complication readiness (BPCR) plans to reduce delays in seeking health care during maternal complications. While studies evaluating SHGs and embedded health programs have demonstrated the gain in knowledge of routine maternal services such as antenatal care and institutional delivery (32,36,44,51), no study till date examined the incremental impact of program participation on knowledge of maternal danger signs among women or the women's likelihood of identifying the risks of complications during the pregnancy, delivery and post-partum period. Moreover, there is limited evidence about the effects of broader individual, household, community, and area-level confounders on knowledge of danger signs among members and non-members of integrated micro nance and health literacy (IMFHL) program in rural settings.…”