Evaluating the Integration of Health and Nutrition Messages Into Self-Help Groups in India

In Bihar and Uttar Pradesh, India, Population Council researchers are evaluating the effect of behavior change communication interventions among women in self-help groups.

The Issue

More than a quarter of the world’s reported maternal and child mortality occurs in India and within India, the states of Uttar Pradesh and Bihar account for around half of the country’s maternal and child disease burden. And three out of every five children and/or adolescents are anemic. Rural and marginalized poor face considerable barriers and are among the most vulnerable populations, lacking both access to services and basic health information. There is an urgent need and opportunity to explore community-based solutions that can extend the reach of health and nutrition services and link to the lower levels of the state health system.

The Progress

In recent years, women’s self-help groups have been shown as an effective social platform for empowering marginalized populations and improving access to micro-finance. There are currently more than 800,000 active self-help groups in Bihar and 175,000 more in Uttar Pradesh. Typically, such groups include spaces in which eight to twelve women can come together and learn financial literacy, save money, and support each other. Since 2012, Population Council evaluations have demonstrated these groups as a promising platform for supporting maternal and newborn health, through the sharing of pertinent health and nutritional information and providing mutual support.

Today, the Population Council is working to rigorously evaluate whether and how a broad range of interventions through self-help groups can lead to positive behavior change and access to services in reproductive, maternal, newborn and child health and nutrition. Interventions include behavior change communication, access to frontline workers and services, nutritional awareness for mother and child, mobile phone engagement to provide women with key messages, and women’s financial autonomy and empowerment approaches.

From 2012 to 2020, a series of quasi-experimental studies will be conducted in Uttar Pradesh and Bihar, India to document the effects of integrating health and nutrition messaging into empowerment pathways across three different groups of women with young children:

  • Women with young children who belong to households where a woman is a member of a self-help group and has received messages on maternal and child health and nutrition through the groups’ efforts;
  • Women with young children who belong to households where a woman is a member of a self-help group but has not received messages on maternal and child health and nutrition; and
  • Women with young children who belong to a household with no self-help group member.

The Impact

Preliminary results suggest a significant increase in healthy maternal and child behaviors among those women who were exposed to health and nutrition interventions through self-help groups. In just two years of integrating health programs into self-help groups, there is a significant improvement in life-saving maternal health and newborn care practices. This has proven to be a cost-effective mechanism in saving lives, especially among the most marginalized populations.

Based on the Population Council’s evidence, the Government of Bihar, together with the World Bank, decided in 2016 to scale-up health and nutrition interventions across 685,000 groups, reaching almost seven million women.

This rigorous evaluation will add to the evidence-base regarding a promising intervention platform and will address several gaps in the evidence to ensure that potential scale-up of the approach is undertaken effectively, efficiently, equitably, and is sustainable by state governments.

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