The Effect of Self Help Groups on Access to Maternal Health Services: Evidence from Rural India

Abstract

Introduction: The main challenge for achieving universal health coverage in India is ensuring effective coverage of poor and vulnerable communities in the face of high levels of income and gender inequity in access to health care. Drawing on the social capital generated through women's participation in community organizations like SHGs can influence health outcomes. To date, evidence about the impact of SHGs on health outcomes has been derived from pilot-level interventions, some using randomised controlled trials and other rigorous methods. While the evidence from these studies is convincing, our study is the first to analyse the impact of SHGs at national level. Methods: We analyzed the entire dataset from the third national District Level Household Survey from 601 districts in India to assess the impact of the presence of SHGs on maternal health service uptake. The primary predictor variable was presence of a SHG in the village. The outcome variables were: institutional delivery; feeding new-borns colostrum; knowledge about family planning methods; and ever used family planning. We controlled for respondent education, wealth, heard or seen health messages, availability of health facilities and the existence of a village health and sanitation committee.

Effect of sharing health messages on antenatal care behavior among women involved in microfinance-based self-help groups in Bihar India

“…The findings from this study, following an intervention that provided information on correct ANC to women in SHGs, reveal significant increases in most ANC outcomes within 1 year of the intervention, compared to unexposed matched SHG women, after controlling for respondents' socio-demographic characteristics. This is consistent with similar research on the effects of SHG interventions, demonstrating that combining a health program with microfinance-based SHG activities is associated with significant increases in maternal care services [12,22]. As evident from other studies conducted in Nepal and Maharashtra, leveraging microfinance-based SHGs to promote health outcomes is beneficial to the health and well-being of their members [23].…”

“…Improvements in several ANC practices can be explained by an increase in SHG members reporting accompaniment by fellow group members to ANC visits. This reveals that SHGs are not only a platform to alleviate poverty, but are an efficient and effective model for building social capital through collectivization and cohesion, which play a vital role in the development of marginalized populations [12,23,24]. Health information supplied through SHGs provides an added benefit of mutual support among members for ANC service access.…”

“…The Makwanpur trial in Nepal implemented a participatory learning cycle through women's SHGs that was followed by an 88% reduction in maternal mortality and a 30% reduction in neonatal mortality after 3 years [11]. Similar interventions in the Indian states of Jharkhand and Orissa found that infants born to SHG mothers had significantly improved chances of survival within the first 6 weeks of life compared to infants born to women who were not SHG members [12]. These studies, however, fail to measure effects of such interventions at scale, and with comparison groups as controls, impeding the scalability and sustainability of such interventions.…”

Indian Women as Entrepreneurs

“…Th ere is now an escalation in social participation and meetings at the community and village levels, increased engagement in political activities, a desire to adopt leadership roles and, most critically, a willingness to challenge the notion that choices involving a woman's health are not her domain. Th ere are studies to indicate that membership in SHGs generates overall awareness in terms of a newfound willingness to partake in health decisions concerning oneself and one's family (Saha, Annear, & Pathak, 2013 ).…”

“…Th is interplay culminates in women taking their fi rst steps into small businesses with the help of linkages provided by the SHG. Bridging and bonding social capital encourages women to take an interest in maternal and child health care and family planning measures (Saha et al, 2013 ).…”