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

项目摘要 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， 怀孕是意外的，年轻妇女的需求得不到满足的风险最高， 避孕。新的证据表明，在这种情况下，年轻的新婚女性希望推迟 怀孕，但避孕措施使用率低，意外怀孕率高， 健康知识。印度的年轻妇女也没有足够的权力，她们希望得到生活技能培训， 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侧重于赋予妇女权力（包括生活技能和健康， 在印度，特别是在年轻已婚妇女中。该提案测试了 生活技能和健康赋权相结合的干预措施对年轻已婚妇女避免 意外怀孕以及其他健康和赋权成果。干预，DAMINI，目前正在 正在印度北方邦的村庄进行，该提案的目标是进行一项双臂随机 （1）DAMINI（生活技能和健康赋权）;和（2）护理健康教育标准的集群研究 以及获得社区卫生工作者提供的避孕药具。这种做法将集中在最近 年龄在18-25岁之间的已婚妇女，她们有怀孕的危险，但在怀孕时不想怀孕。 并将通过亲自调查在干预后跟踪他们两年。达米尼交付 我们将在40个干预村和40个对照村开展工作;每个村1组，6-7个 每个群组/组中的女性（总N=520）。我们还将收集纵向三位一体的深度访谈， 新婚妇女、她们的丈夫和岳母，以了解不断变化的规范和途径， 冲击第一个目的是确定DAMINI对发生意外事件风险的有效性。 与单纯的健康教育相比，至妊娠时间（主要结局）的生存分析将 用于分析对意外怀孕的影响。考虑到影响经产与 对于未经产的妇女，我们将分别模拟DAMINI对她们的影响，并包括特定的产次 第二个目标是评估在家庭中， DAMINI对生活技能和健康赋权相关中间结果的有效性， 健康教育，使用相同的方法。最后，为今后的实施提供信息 研究，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、DAMINI和社区领导人进行评估。这也将包括一个 经济评价，特别是成本效益分析。如果被证明有效，预计这将 干预措施可以纳入现有的自助团体，并在印度（和南方其他地区）扩大规模。 亚洲），以改善妇女和儿童的健康，长期的经济和赋权相关的成果。

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.