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Authors
Lu Gram1, Joanna Morrison1, Naomi Saville1,2, Bhim Shrestha2, Shyam Sundar Yadav2, Dharma Manandhar2, Anthony Costello1,3, Jolene Skordis-Worrall1
1 Institute of Global Health, University College London, UK
2 Mother Infant Research Activities, Nepal
3 Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Switzerland
Background
Participatory women's groups (WGs) in maternal and child heath have proven effective in reducing maternal and neonatal mortality in many settings and are often claimed to empower women, yet quantitative evaluations have been lacking.
Method
Our study is embedded in a four-arm cluster-randomized controlled trial comparing the effects on low birth weight of 1) participatory women's groups alone 2) WGs combined with monthly cash transfers 3) WGs combined with food transfers. 1309 pregnant women were interviewed in their third trimester between June and August 2015 and asked about their motivations for outside work, domestic work, health-seeking and group participation. The main outcome was overall agency freedom.
Results
Participation rates in WGs increased from 34% in the WGs only arm to 90-96% in the combined WGs and transfer arms (p<0.001). Intention-to-treat estimates revealed increased overall agency freedom scores in the WGs and cash arm (0.35 SDs, SE 0.13), but no evidence for an effect of WGs alone (0.08 SDs, SE 0.15) or WGs and food (0.00 SDs, SE 0.13). Interaction tests revealed no evidence for differences in effect according to private savings, household food security or presence of friendships.
Conclusion
Participatory women's groups alone may not be able to alter overall agency freedom unless change is resourced externally, but WGs combined with cash transfers may increase the agency freedom of pregnant women.