Formative evaluation of a participatory women's group intervention to improve reproductive and women's health outcomes in rural Bangladesh: a controlled before and after study

Abstract

Background Women's groups using participatory methods reduced newborn mortality in rural areas of low income countries. Our study assessed a participatory women's group intervention that focused on women's health, nutrition and family planning. Methods The study was conducted in three districts in Bangladesh between October 2011 and March 2013, covering a population of around 230 000. On the basis of allocation for the preceding cluster randomised trials, three unions per district were randomly allocated to receive a women's group intervention and three per district were control clusters. Outcomes included unmet need for family planning, morbidity, dietary diversity, night blindness, healthcare decision-making and knowledge of sexual and reproductive health, nutrition and anaemia. A difference-in-difference analysis was used to adjust for secular trends and baseline differences between women taking part in the intervention and a random sample from control clusters. Results We interviewed 5355 (91% response rate) women before the intervention and 5128 after (96% response rate). There were significant improvements in women's dietary diversity score (increase of 0.2 (95% CI 0.1 to 0.3)) and participation in healthcare decisionmaking ( proportion increase (95% CI) 14.0% (10.6% to 17.4%)). There were also increases in knowledge about: contraception (4.2% (2.0% to 6.3%)), ways to treat (55.4% (52.2% to 58.5%)) and prevent (71.0% (68.0% to 74.1%)) sexually transmitted infections, nutrition (46.6% (43.6% to 49.6%)) and anaemia prevention (62.8% (60.9% to 64.6%)). There were no significant differences in unmet need for family planning, morbidity or night blindness. Conclusions Participatory women's groups have considerable potential to improve women's health knowledge, but evidence of impact on certain outcomes is lacking. Further formative work and intervention development is needed to optimise the impact of this approach for women's health.

Impact on birth weight and child growth of Participatory Learning and Action women’s groups with and without transfers of food or cash during pregnancy: Findings of the low birth weight South Asia cluster-randomised controlled trial (LBWSAT) in Nepal

“…Although PLA alone has been effective in reducing neonatal mortality [ 27 ], and in changing nutrition-related behaviours [ 25 , 30 , 31 , 42 ], effects of PLA alone on birthweight were not large enough to reach significance in our study. This is consistent with the lack of effect of PLA plus home visits on birthweight found by Nair et al [ 25 ].…”

“…However we found that nutrition education interventions using participatory community-based approaches focused on practical behaviour were more likely to be effective than knowledge transfer alone [ 26 ]. Moreover, PLA with women’s groups was effective in reducing other health outcomes, including neonatal and maternal mortality in rural communities [ 27 ], and was pro-poor in coverage [ 28 ] and impact [ 29 ], and may influence nutrition-related behaviours [ 30 ] and dietary diversity [ 31 ].…”

Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN) trial comparing three variants of a nutrition-sensitive agricultural extension intervention to improve maternal and child nutritional outcomes in rural Odisha, India: study protocol for a cluster randomised controlled trial

“…Participatory interventions with women’s groups using a Participatory Learning and Action (PLA) approach have shown large positive impacts on essential newborn care practices and have reduced neonatal deaths [ 38 ]. These interventions have also shown large effects on women’s nutritional knowledge and dietary diversity [ 39 , 40 ], but limited impacts on maternal and child nutritional status [ 40 ]. In PLA groups, women acquire new nutrition knowledge, receive social support from peers and the community, and exercise both problem-solving and decision-making power [ 41 ].…”

Long-term impact of community-based participatory women’s groups on child and maternal mortality and child disability: follow-up of a cluster randomised trial in rural Nepal

“…Community-level exposure (to a lesser degree) and individual attendance (to a greater degree) at the groups appears to result in changes in home birth practices and careseeking behaviour for maternal health,5 7 10 leading to reductions in maternal infection rates and more timely intervention as required at delivery 5 7. Women attending the groups, at least in the short term, perceive them to have resulted in increased self-confidence and self-esteem, greater social support12 13 and increased participation in household decision-making, particularly around healthcare (although other studies have not shown impact on household decision making) 14 15. Qualitative data suggest they can build solidarity, share resources, reduce stress and assist communities to lobby for better access to care and rights 16…”