Increasing knowledge of home based maternal and newborn care using self-help groups: Evidence from rural Uttar Pradesh, India

Singh

et al. 2020

Preprint

Background Women from marginalized communities have poorer maternal health outcomes and limited utilization of health services compared to other communities. There is empirical evidence that comprehensively designed interventions targeting health education of women and social determinants of health, such as financial security, have better outcomes than focusing on health education alone. A community-based intervention was implemented to improve maternal, child, and adolescent health practices in marginalized communities. Besides, the project aimed to promote financial literacy and enhance livelihood opportunities for young people. This three-year peer-led intervention was done in the two districts of Rajasthan, namely Nagaur and Pali. The paper aimed at assessing the effectiveness of this community-based intervention.Methods Pre-post study design based on qualitative research was used for the evaluation of the intervention. Purposive sampling was done both at baseline and the end-line assessments. Focus group discussions were done with women (15-49 years) and adolescents (10-19 years), and in-depth interviews with frontline workers and village health committees were done. Content analysis was done.Results Overall, 4853 women, and 8158 adolescents were engaged in the intervention in two districts. We found a noticeable change in some of the practices like institutional delivery, breastfeeding, uptake of antenatal care among women, and knowledge about sexual and reproductive health among adolescents. Around 23% and 67% of the young people from Nagaur and Pali, respectively, were linked with jobs in computer training centers, tailoring centers, and beauty parlors. However, we found a lack of change in some of the indicators, such as knowledge about HIV testing during pregnancy, uptake of contraceptives, and iron-folic acid consumption among women. Early marriage was widely prevalent in the districts, the reduction of which was underachieved. In the interviews, frontline workers reported having been impartial and inclusive in delivering health services.Conclusions We found evidence suggesting that peer-led interventions are equally effective in improving maternal and child health practices and livelihood promotion. The gaps at system-level, coupled with the presence of specific socio-cultural contextual factors might explain for lack of improvement in some of the indicators.

Section: Discussionsupporting

confidence: 87%

“…Nagaur: Of the total 210 young people who attended the training, 171 were in the age group of [16][17][18][19] years, and 39 were in the age group of 19-25 years. Hundred and sixteen (55%) out of the total 210 were girls, and 94 were boys (45%).…”

Section: Financial Literacy and Livelihood Promotion Training Programmentioning

confidence: 99%

Evaluation of an integrated health and livelihood development program for marginalized communities in India

Sharma

Singh

et al. 2020

Preprint

“…Pali: Of the total 164 young people who attended the training, 123 were in the age group of [16][17][18][19] years, and 40 were in the age group of 19-25 years. Eighty-nine (54.6%) out of the total 163 were girls, and 74 were boys (45.4%).…”

Section: Financial Literacy and Livelihood Promotion Training Programmentioning

confidence: 99%

Evaluation of an integrated health and livelihood development program for marginalized communities in India

Sharma

Singh

et al. 2020

Preprint

Background: Women from marginalized communities have poorer maternal health outcomes and limited utilization of health services compared to other communities. There is empirical evidence that comprehensively designed interventions targeting health education of women and social determinants of health, such as financial security, have better outcomes than focusing on health education alone. A community-based intervention was implemented to improve maternal, child, and adolescent health practices in marginalized communities. Besides, the project aimed to promote financial literacy and enhance livelihood opportunities for young people. This three-year peer-led intervention was done in the two districts of Rajasthan, namely Nagaur and Pali. The paper aimed at assessing the effectiveness of this community-based intervention. Methods: Pre-post study design based on qualitative research was used for the evaluation of the intervention. Purposive sampling was done both at baseline and the end-line assessments. Focus group discussions were done with women (15-49 years) and adolescents (10-19 years), and in-depth interviews with frontline workers and village health committees were done. Content analysis was done. Results: Overall, 4853 women, and 8158 adolescents were engaged in the intervention in two districts. We found a noticeable change in some of the practices like institutional delivery, breastfeeding, uptake of antenatal care among women, and knowledge about sexual and reproductive health among adolescents. Around 23% and 67% of the young people from Nagaur and Pali, respectively, were linked with jobs in computer training centers, tailoring centers, and beauty parlors. However, we found a lack of change in some of the indicators, such as knowledge about HIV testing during pregnancy, uptake of contraceptives, and iron-folic acid consumption among women. Early marriage was widely prevalent in the districts, the reduction of which was underachieved. In the interviews, frontline workers reported having been impartial and inclusive in delivering health services. Conclusions: We found evidence suggesting that peer-led interventions are equally effective in improving maternal and child health practices and livelihood promotion. The gaps at system-level, coupled with the presence of specific socio-cultural contextual factors might explain for lack of improvement in some of the indicators.

“…Multiple studies have proven the effectiveness of peers in CBI for empowering women and improving the health status of mother and children. [12][13][14] Community engagement (CE) is central to CBI, and a cost-effective tool for sustained behavior change. 11,15.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a community-based intervention for health and economic empowerment of marginalized women in India

Sharma¹,

Mehra

et al. 2019

Preprint

Background Empowered women have improved decision-making capacity and can demand equal access to health services. Community-based interventions (CBI) based on building women’s groups for awareness generation on maternal and child health (MCH) are the best and cost-effective approach in improving their access to health services. The present endeavor evaluates a community-based intervention aimed at improving marginalized women’s health and economic status using the peer-led approach from two districts of India. Methods We used peer educators as mediators of knowledge transfer among women and for creating a supportive environment at the household and community-level. The intervention was implemented in two socially backward districts of Uttar Pradesh, namely Kaushambi and Banda. Two development blocks in each of the two districts were selected randomly, and twenty-four villages in each of the four blocks were selected based on the high percentage of a marginalized population. The evaluation of the intervention involved a non-experimental, pre- and post-research design, using a mixed-method approach. Data were collected at three points in time, including a rapid assessment (quantitative and qualitative interviews) at baseline, qualitative interviews at the end line and tracking data of the intervention population (n=37,324) through an online management information system. Results Most of the women in Banda (90%) and Kaushambi (85%) attended at least 60% of the education sessions. Around 39% of women in Banda and 35% of women in Kaushambi registered for livelihood scheme, and 94% and 80% of them had worked under the scheme. Women during group discussions informed that their awareness about MCH increased post-intervention. The money earned after getting work under livelihood scheme or from daily savings was deposited in the bank account by the women. These savings had helped women investing money at the times of need, such as starting their work, in emergencies for the medical treatment of their family members, education of their children, etc. Conclusion Considering the interlinked plexus of literacy, social status, economic empowerment, and health status of women, interventions targeting anyone of them in silos may not achieve the desired results. The study provides scientific evidence of the successful implementation of peer-led community-based intervention model..