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

Abstract

a b s t r a c tBackground: Despite the health system effort s, health disparities exist across sub-populations in India. We assessed the effects of health behaviour change interventions through women's self-help groups (SHGs) on maternal and newborn health (MNH) behaviours and socio-economic inequalities. Methods: We did a quasi-experimental study of a large-scale SHG program in Uttar Pradesh, India, where 120 geographic blocks received, and 83 blocks did not receive health intervention. Data comes from two cross-sectional surveys with 4,615 recently delivered women in 2015, and 4,250 women in 2017. The intervention included MNH discussions in SHG meetings and community outreach activities. The outcomes included antenatal, natal and postnatal care, contraceptive use, cord care, skin-to-skin care, and breastfeeding practices. Effects were assessed using multilevel mixed-effects regression adjusted differencein-differences (DID) analysis adjusting for geographic clustering and potential covariates, for all, mostmarginalised and least-marginalised women. Concentration indices examined the socio-economic inequality in health practices over time. Findings: The net improvements (5-11 percentage points [pp]) in correct MNH practices were significant in the intervention areas. The improvements over time were higher among the most-marginalised than least-marginalised for antenatal check-ups (DID: 20pp, p < 0 • 001 versus DID: 6pp, p = 0 • 093), consumption of iron folic acid tablets for 100 days (DID: 7pp, p = 0 • 036 versus DID: -1pp, p = 0 • 671), current use of contraception (DID: 12pp, p = 0 • 046 versus DID: 10pp, p = 0 • 021), cord care (DID: 12pp, p = 0 • 051 versus DID: 7pp, p = 0 • 210), and timely initiation of breastfeeding (DID: 29pp, p = 0 • 001 versus DID: 1pp, p = 0 • 933). Lorenz curves and concentration indices indicated reduction in rich-poor gap in health practices over time in the intervention areas. Interpretation: Disparities in MNH behaviours declined with the effort s by SHGs through behaviour change communication intervention.

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

“…The SHG platform is the underlying developmental model of the IMFHL program evaluated in this paper. The IMFHL program aimed to empower marginalised women by organising them in self-help groups comprising 10-15 households to adopt desired health behaviours and provide access credit for poverty reduction (44,45). Studies have shown that SHG membership fosters social capital and cohesion among member through group collectivisation, with membership in uencing social norms and behaviours (39,40,41).…”

“…While most studies attribute the change in health behaviours due to the in uence of program input, limited studies have explored the phenomenon of diffusion of health literacy from program members to non-members (44,39,46). Diffusion in this paper adopts a de nition that explains the process by which an innovation -in this case, the knowledge of maternal danger signs, is communicated through programmatic channels over time from members to non-members of a social system (43).…”

“…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.…”

“…The IMFHL program was implemented by a consortium comprising of Public Health Foundation of India (PHFI), Population Council (PC), Boston University (BU), and Rajiv Gandhi Mahila Vikas Pariyojan (RGMVP) but funded by the Bill and Melinda Gates Foundation (BMGF) (44).…”