Integrated multisectoral strategy to improve girls’ and women’s nutrition before conception, during pregnancy and after birth in India (Swabhimaan): protocol for a prospective, non-randomised controlled evaluation

Abstract

IntroductionSwabhimaan is a community-based programme to improve adolescent girls’ and women’s nutrition in the rural areas of three Indian states—Bihar, Chhattisgarh and Odisha with high prevalence of undernutrition.Methods and analysisSwabhimaan has a nested prospective, non-randomised controlled evaluation. Since 2017, five intervention sites receive community-led interventions through national government’s livelihood mission supported women’s self-help group federations and five control sites will initiate these activities 36 months later, in 2020. Community-led activities aim to improve coverage of 18 interventions including adequacy of food consumed, prevention of micronutrient deficiencies, access to basic health services and special care of nutritionally ‘at risk’ girls and women, improving hygiene and access to water and sanitation services and access to family planning services. The evaluation includes baseline (2016–2017), midline (2018–2019) and endline (2020–2021) surveys covering 6638 adolescent girls, 2992 pregnant women and 8755 mothers of children under 2. The final impact analysis will be by intention to treat, comparing primary and secondary outcomes in five intervention areas and five control areas. The primary outcomes are: (1) a 15% reduction in the proportion of adolescent girls with a body mass index (BMI) <18.5 kg/m2; (2) a 15% reduction in the proportion of mothers of children under two with a BMI <18.5 kg/m2 and (3) and a 0.4 cm improvement in mean mid-upper arm circumference among pregnant women.Ethics and disseminationAll procedures involving human subjects were approved by the Institutional Ethics Committee of the All India Institute of Medical Sciences, Bihar, Chhattisgarh and Odisha and in compliance with guidelines laid down in the Declaration of Helsinki. Evidence will inform maternal and preconception nutrition policy at national and state level.Trial registration number58261b2f46876 and CTRI/2016/11/007482; Pre-results.

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

“…8,43 an ongoing nutrition pilot in 3 states of India engages with SHG federations through participatory, community-based mapping of nutrition needs and active convergence across government departments to extend intervention reach. 18 In another approach, interventions to address malaria and dengue in urban and rural areas assigned SHG members a set number of houses in the community to monitor bednet usage, actively working with groups as a conduit to reach the community in support of public health campaigns. 44,45 Community mobilization interventions implemented at scale in India indicate the possibility of inviting other concerned women in the community to SHG meetings, which may improve participation in meetings as well.…”

“…16 For example, the Bill & Melinda Gates Foundation, UNICEF, and the World Bank have each supported different types of pilot interventions to improve women's and children's health and nutrition through SHGs. [17][18][19] In 2017, the Ministry of Rural Development issued an advisory for SHGs to integrate information on food, nutrition, and health with water, sanitation, and hygiene into SHG meetings, an approach which is gradually being scaled across several states. 20 There are 3 potential advantages of integrating health interventions into existing microfinancebased SHGs -commonly known as "layering"in India.…”

An Adaptation of the Food Insecurity Experience Scale (FIES) for Measuring Food Insecurity Among Women in Socially- Backward Communities

“…This work uses baseline survey data from the SWABHIMAAN programme, a collaborative project of UNICEF India and the National Rural Livelihood Mission of Ministry of Rural Development and Panchayati Raj, Government of India (Sethi et al 2019;Reshmi et al 2019). The SWABHIMAAN programme covers 8,755 lactating mothers in socially-backward communities and combines interventions at both community and system-based levels.…”

“…The sample for the SWABHIMAAN programme baseline survey was designed to provide estimates of key indicators at block levels across the states of Bihar, Odisha, and Chhattisgarh. For this purpose, a prospective, non-randomized controlled study was implemented, in which five areas (intervention arm) have been purposively allocated to community-led interventions delivered through village organizations and cluster/gram panchayat level federations since 2017 (Sethi et al 2019;UNICEF 2016). A representative sample of 8,755 mothers (2,612 from Bihar; 3,604 from Odisha; and 2,539 from Chhattisgarh) was derived using simple random sampling after adjusting for non-response rate.…”

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

“…India's National Health Mission, National AIDS Control Program and National Rural Livelihoods Mission implement a range of women's group interventions to improve maternal and child health, nutrition and HIV-related outcomes. [14][15][16][17] Ethiopia's Women's Development Army has worked with groups to improve maternal health for over 15 years. 18 Nigeria aims to tackle gender-based violence through livelihoods-based women's affinity groups.…”