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

项目总结 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，一半的人 怀孕是意外的，年轻女性有未得到满足的需求的风险最高 避孕。新的证据表明，在这种情况下，年轻的新婚女性渴望推迟 怀孕，但避孕措施使用率低，意外怀孕率高，并希望生育 健康知识。印度的年轻女性赋权也很低，她们希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。几乎没有几个严格 设计和测试的干预措施侧重于赋予妇女权力(包括生活技能和健康-- 与此相关)和意外怀孕，特别是在印度的年轻已婚妇女中。这项提案考验着 年轻已婚女性生活技能和健康赋权综合干预对避免 意外怀孕以及其他健康和赋权结果。干预，达米尼，目前正在 在印度北方邦的村庄正在进行，这项提议的目标是进行双臂随机 关于(1)达米尼(生活技能和健康赋权)的分组研究；和(2)保健健康教育标准 以及获得社区卫生工作者提供的避孕药具。这一方法将集中在最近 18-25岁有怀孕风险但不想怀孕的已婚妇女 并将通过面对面调查在干预后对他们进行为期两年的跟踪调查。达米尼被送来了 在小组中，我们将在40个干预村群和40个对照村群中工作；每个群组1个小组，6-7个 每一组/组的妇女(总计N=520人)。我们还将收集纵向三人深入采访 新婚妇女，她们的丈夫和婆婆，了解变化的规范和途径 冲击力。第一个目标是确定达米尼对意外死亡风险的有效性。 与单纯的健康教育相比，怀孕。妊娠时间(主要结局)的生存分析 用于分析对意外怀孕的影响。考虑到影响分娩与分娩的潜在不同因素 未分娩的妇女，我们将分别模拟达米尼对她们的影响，并包括特定于产次的 衡量指标，如以前出生的性别和结婚后的时间。第二个目标是评估 达米尼对与生活技能和健康赋权相关的中介结果的有效性 只进行健康教育，采用同样的方法。最后，为今后的实施提供信息 研究中，我们将使用有效性-实现混合设计来进行混合方法过程 与参与者及其家庭、达米尼和社区领袖一起进行评估。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，预计这一点 干预措施可以整合到现有的自助小组中，并在印度(和南方其他地区)扩大规模 (亚洲)改善妇女和儿童的健康、长期经济和赋权方面的成果。

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.