The impact of group-based life skills and health empowerment for young, married, women to avoid unintended pregnancies in India.

项目概要 意外怀孕使妇女面临孕产妇和儿童健康状况不佳的风险。在印度，一半 怀孕是意外的，年轻女性的需求未得到满足的风险最高 避孕。新证据表明，在这种情况下，年轻的新婚女性希望推迟结婚 怀孕，但避孕措施使用率低，意外怀孕率高，并且渴望生育 健康知识。印度的年轻女性赋权能力也较低，她们渴望接受生活技能方面的培训 可以用来帮助他们在家庭和社区中获得地位和机会。很少严格 设计和测试的干预措施重点关注妇女赋权（包括生活技能和健康技能） 相关）和意外怀孕，尤其是印度的年轻已婚妇女。该提案测试了 针对年轻已婚妇女的生活技能和健康赋权综合干预措施对避免 意外怀孕以及其他健康和赋权结果。干预措施 DAMINI 目前正在 印度北方邦的村庄正在进行这项研究，该提案的目标是进行一项双臂随机试验 (1) DAMINI（生活技能和健康赋权）的聚类研究； (2)护理健康教育标准 以及获得社区卫生工作者提供的避孕药具。该方法将重点关注最近 18-25岁有怀孕风险但在怀孕时不想怀孕的已婚女性 并将在干预后两年内通过现场调查对其进行跟踪。 DAMINI 已交付 分批开展40个干预村组和40个控制村组的工作；每簇 1 组，6-7 个 每个集群/组中的女性（总数 N=520）。我们还将收集纵向三元深度访谈 新婚妇女、她们的丈夫和婆婆了解不断变化的规范和途径 影响。第一个目标是确定 DAMINI 对意外风险的有效性 与单纯的健康教育相比，怀孕。妊娠时间的生存分析（主要结果）将 用于分析对意外怀孕的影响。鉴于影响经产与经产的潜在不同因素 对于未生育过的女性，我们将分别模拟 DAMINI 对她们的影响，并包括特定的产次 诸如前次生育的性别和结婚后的持续时间等措施。第二个目的是评估 与相比，DAMINI 对与生活技能和健康赋权相关的中间结果的有效性 仅使用相同的方法进行健康教育。最后，通知今后的实施 研究中，我们将使用有效性-实施混合设计来进行混合方法过程 与参与者及其家庭以及 DAMINI 和社区领导进行评估。这还将包括一个 经济评估，特别是成本效益分析。如果被证明有效的话，预计这 干预措施可以纳入现有的自助团体，并在印度（以及南方其他地区）扩大规模 亚洲）以改善妇女和儿童的健康、长期经济和赋权相关成果。

PROJECT SUMMARY Unintended pregnancies put women at risk of poor maternal and child health outcomes. In India, half of all pregnancies are unintended and younger women have the highest risk of having an unmet need for contraception. New evidence suggests that young, newly married women in this setting desire to postpone pregnancy, yet have low use of contraception and high rates of unintended pregnancy, and desire reproductive health knowledge. Young women in India also have low empowerment, and desire training in life skills that could be used to help them gain status and opportunity in their households and communities. Few rigorously designed and tested interventions have focused on women’s empowerment (including life skills and health- related) and unintended pregnancy, especially among young, married women in India. This proposal tests the impact of a combined life skills and health empowerment intervention for young married women on avoiding unintended pregnancy, and other health and empowerment outcomes. The intervention, DAMINI, is currently on-going in villages in Uttar Pradesh, India, and the goal of this proposal is to conduct a two-arm randomized cluster study of (1) DAMINI (life skills and health empowerment); and (2) the standard of care health education and access to contraceptives provided by community health workers. This approach will focus on recently married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy at the time of enrollment and will follow them for two years post-intervention through in-person surveys. DAMINI is delivered in groups and we will work in 40 intervention and 40 control village clusters; with 1 group per cluster and 6-7 women in each cluster/group (total N=520). We will also collect longitudinal triadic in-depth interviews with newly married women, their husbands, and mothers-in-law to understand changing norms and pathways of impact. The first aim is to determine the effectiveness of DAMINI on the risk of having an unintended pregnancy, compared to health education alone. Survival analysis of time to pregnancy (primary outcome) will be used to analyze the impact on unintended pregnancy. Given potentially different factors affecting parous vs. nulliparous women, we will model the effect of DAMINI on them separately, and include parity specific measures such as sex of previous births and duration since marriage.The second aim is to assess the effectiveness of DAMINI on intermediary outcomes related to life skills and health empowerment, compared to health education alone, using the same methodological approach. Finally, to inform future implementation research, we will use an effectiveness-implementation hybrid design to conduct a mixed methods process evaluation with participants and their households and DAMINI and community leaders. This will also include an economic evaluation, specifically a cost effectiveness analysis. If proven effective, it is anticipated that this intervention could be integrated into existing self help groups and scaled up in India (and other parts of South Asia) to improve women and children’s health, long-term economic and empowerment related outcomes.