Community interventions with women’s groups to improve women’s and children’s health in India: a mixed-methods systematic review of effects, enablers and barriers

Abstract

IntroductionIndia is home to over 6 million women’s groups, including self-help groups. There has been no evidence synthesis on whether and how such groups improve women’s and children’s health.MethodsWe did a mixed-methods systematic review of quantitative and qualitative studies on women’s groups in India to examine effects on women and children’s health and to identify enablers and barriers to achieving outcomes. We searched 10 databases and included studies published in English from 2000 to 2019 measuring health knowledge, behaviours or outcomes. Our study population included adult women and children under 5 years. We appraised studies using standard risk of bias assessments. We compared intervention effects by level of community participation, scope of capability strengthening (individual, group or community), type of women’s group and social and behaviour change techniques employed. We synthesised quantitative and qualitative studies to identify barriers and enablers related to context, intervention design and implementation, and outcome characteristics.FindingsWe screened 21 380 studies and included 99: 19 randomised controlled trial reports, 25 quasi-experimental study reports and 55 non-experimental studies (27 quantitative and 28 qualitative). Experimental studies provided moderate-quality evidence that health interventions with women’s groups can improve perinatal practices, neonatal survival, immunisation rates and women’s and children’s dietary diversity, and help control vector-borne diseases. Evidence of positive effects was strongest for community mobilisation interventions that built communities’ capabilities and went beyond sharing information. Key enablers were inclusion of vulnerable community members, outcomes that could be reasonably expected to change through community interventions and intensity proportionate to ambition. Barriers included limited time or focus on health, outcomes not relevant to group members and health system constraints.ConclusionInterventions with women’s groups can improve women’s and children’s health in India. The most effective interventions go beyond using groups to disseminate health information and seek to build communities’ capabilities.Trial registration numberThe review was registered with PROSPERO: CRD42019130633.

Matching Intent With Intensity: Implementation Research on the Intensity of Health and Nutrition Programs With Women's Self-Help Groups in India

“…Impact evaluations and observational studies indicate some improvements in health behaviors among SHG members through layered interventions. 1,2,25,26 However, global evidence syntheses on women's groups have identified significant gaps in our understanding of how these interventions work-who participates, for how long, what do they do, and how often. 27 Understanding the implementation intensity of these interventions is critical to identifying implementation features specific to women's groups that influence effectiveness, along with transferability and scalability in different settings.…”

Classroom, club or collective? Three types of community-based group intervention and why they matter for health

“…We developed our typology to explain clear differences in health impact by intervention type in a recent systematic review of women's group interventions in India. 7 Importantly, our review highlighted that different types of women's groups, such as microfinance-oriented selfhelp groups or sex workers collectives, can use different intervention ideal types depending on the context. For example, a government-run self-help group programme in Bihar, India, has implemented a classroom intervention to improve dietary diversity, 38 but also a club intervention to reduce gender-based violence 64 and a collective approach with participatory learning and action.…”

“…We recently did a systematic review of the impact of women's groups interventions on health in India which found a clear difference in health impact by intervention type, with interventions building community capacity more likely to achieve changes in population-level health outcomes than those simply offering information. 7 Our present paper builds on this review to offer conceptual tools for thinking through observed differences in health impacts by type of group intervention. We introduce a typology of group interventions and argue that implicit assumptions underpinning different types of intervention matter for their likely health impact.…”

Effects of integrated economic and health interventions with women’s groups on health-related knowledge, behaviours and outcomes in low-income and middle-income countries: a systematic review protocol

“…We build on previous reviews by (1) focusing on the combined effect of group-based economic and health programmes, as distinct from previous reviews that examined the health impacts of joining a microfinance-based group with or without layering 4 or non-group-based microfinance interventions 5 and (2) including studies across all LMICs rather than a specific region. 10 11 …”

“…This paper presents the protocol, following Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines, 10 for a review we will conduct, which aims to address this gap through synthesising quantitative and qualitative evidence on the health effects of combined group-based economic and health interventions and implementation factors that contributed to achieving intended outcomes. We aim to answer two primary questions: (1) What is the effect of combined economic and health, nutrition and/or sanitation interventions delivered through women’s groups on health outcomes among women and children in LMICs, compared with single-purpose, non-layered (ie, only economic or only health) interventions with women’s groups or to no group intervention, and (2) what factors related to intervention content, context and implementation processes are enablers or barriers to achieving health outcomes?…”