Achieving better pregnancy, newborn health and healthy behaviour among the rural poor in India: evidence from a large-scale randomly placed project
Speaker: Dr Arnab Acharya, Professor & Vice-Dean, Jindal School of Government and Public Policy, Sonipat, Haryana
Date: February 8, 2013; 3.30-5.00 pm
Venue: Conference Room, 2nd Floor, TERI University, New Delhi
The project Sure Start (SS) in Uttar Pradesh, India was motivated by a number of small scale studies showing that community-level interventions can promote better care-seeking and healthy behaviours by mothers and family members to reduce newborn mortality and morbidity in a rural poor environment with low-level of education among women. Commencing in 2007 in seven rural districts with a population of 19 million, the content of the SS intervention was similar to those in past studies but was implemented through the use of existing government health infrastructure.
The evaluation of the project seeks to assess the feasibility of large-scale implementation of community-level interventions to promote healthier pregnancy through promotion of healthy behaviour.
Interventions were implemented at two levels of intensity. The unit of intervention was the gram-panchayat—the lowest level of governance unit in India. Forty percent of the panchayats were randomly selected to receive a more intense intervention that included periodic, community-level meetings with expectant mothers (mother’s group meeting). Two rounds of surveys of 12,000 women who completed pregnancy were undertaken: a baseline in 2007 and another three years after the implementation, in 2010.
Areas with the more intensive intervention experienced significantly higher improvements over time in morbidity and healthy behaviour, but similar results were not significant for neonatal mortality. Local Average Treatment Effect analysis confirms that pathway to change can be attributed to mother’s group meetings. The lowest caste group experienced greater change. Community-level interventions when scaled up can improve healthy behaviour and likely to have helped improve health.