Article Text

Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial
  1. Nirmala Nair1,
  2. Prasanta K Tripathy1,
  3. Rajkumar Gope1,
  4. Shibanand Rath1,
  5. Hemanta Pradhan1,
  6. Suchitra Rath1,
  7. Amit Kumar1,
  8. Vikash Nath1,
  9. Parabita Basu1,
  10. Amit Ojha1,
  11. Andrew Copas2,
  12. Tanja AJ Houweling3,
  13. Hassan Haghparast-Bidgoli2,
  14. Akay Minz4,
  15. Pradeep Baskey4,
  16. Manir Ahmed4,
  17. Vasudha Chakravarthy5,
  18. Riza Mahanta5,
  19. Audrey Prost2
  1. 1Ekjut, Chakradharpur, India
  2. 2Institute for Global Health, University College London, London, UK
  3. 3Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
  4. 4Jharkhand State Health Mission, Ranchi, India
  5. 5Development Solutions, New Delhi, India
  1. Correspondence to Prof Audrey Prost; audrey.prost{at}


Introduction The WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers.

Methods We did a pragmatic cluster non-randomised controlled trial of women’s groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand’s 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017–31 August 2017) and evaluation periods (1 September 2017–31 August 2019). The primary outcome was neonatal mortality.

Results We identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand’s 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026–max: 20 527) over 42 months, and cost 41 international dollars per life year saved.

Conclusion Participatory women’s groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings.

Trial registration ISRCTN99422435.

  • child health
  • public Health
  • maternal health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. De-identified participant data and a STATA do file to replicate analyses are included as supplementary files with our publication.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. De-identified participant data and a STATA do file to replicate analyses are included as supplementary files with our publication.

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  • Handling editor Seye Abimbola

  • Twitter @audreyprost2

  • Contributors AP conceptualised the study and developed its methods with HP, NN, ShR, SuR, PKT, VN, RG, and AK. HP, AP, TH and AC carried out the analyses. ShR and HP led the quantitative data collection and cleaning. SuR led the analysis of the qualitative data. VC and RM collected and analysed data for the third-party evaluation by Development Solutions used to estimate effects of the intervention at scale. PBasu analysed data from the Monitoring and Information System. AO and HH-B led the collation and analysis of cost data. AP wrote the first draft of the article and collated subsequent inputs. All authors, including AM, PBask and MA, commented on drafts of the manuscript. AP acquired the funding and oversaw the grant that funded the study. AP, HP and TH had access to all underlying data. AP acts as guarantor.

  • Funding The study was funded by the Children’s Investment Fund Foundation (grant number G160100937). The funder had no role in designing the study, data collection and analysis, the decision to publish or the preparation of this manuscript.

  • Competing interests AM, PBask and MA are employed by Jharkhand’s State Health Mission. Other authors declare that they have no conflicts of interest.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.