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Original research
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
  1. Sapna Desai1,
  2. Madhavi Misra1,
  3. Aikantika Das1,
  4. Roopal Jyoti Singh1,
  5. Mrignyani Sehgal2,
  6. Lu Gram3,
  7. Neha Kumar4,
  8. Audrey Prost5
  1. 1Population Council India, New Delhi, Delhi, India
  2. 2International Food Policy Research Institute, New Delhi, India
  3. 3Institute for Global Health, University College London, London, UK
  4. 4International Food Policy Research Institute, Washington, DC, USA
  5. 5University College London Institute of Child Health, London, UK
  1. Correspondence to Dr Sapna Desai; sdesai{at}popcouncil.org

Abstract

Introduction India 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.

Methods We 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.

Findings We 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.

Conclusion Interventions 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 number The review was registered with PROSPERO: CRD42019130633.

  • public health
  • systematic review
  • prevention strategies
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjgh-2020-003304

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @LuGram12, @neha_DC, @audreyprost2

    • Contributors AP and SD conceptualised the systematic review, with input from NK and LG. MM and AP conducted the searches, and MM and MS screened titles and abstracts. SD and AP screened full text. AD, AP, MM, MS, RJS and SD extracted quantitative and qualitative data. SD and AP conducted risk of bias assessments, synthesised findings and drafted the report. All authors reviewed and commented on the report.

    • Funding This review was funded by an award from the Bill and Melinda Gates Foundation (OPP1205836), to the Population Council, who partnered in a consortium with University College London and International Food Policy Research Institute.

    • Competing interests AP, LG, NK and SD have been involved in some of the studies included in the review.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on request. All data relevant to the study are included in the article or uploaded as supplementary information. Extraction sheets are available on request. All other data are included in the article and supplementary files.

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