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

在印度，基于群体的生活技能和健康赋权对年轻、已婚妇女避免意外怀孕的影响。

• 批准号: 10707910
• 负责人: NADIA GRIFFI DIAMOND-SMITH
• 金额: $ 61.41万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707910
• 关键词: Affect; Asia; Birth; Child; Child Health; Communication; Communities; Community Health Aides; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Cost Effectiveness Analysis; Data; Decision Making; Economics; Enrollment; Family; Female Adolescents; Future; Goals; Health; Health Resources; Health Services; Health education; Household; Household and Family; Husband; India; Infant Health; Intention; Intermediate Variables; Intervention; Interview; Laws; Life; Life Cycle Stages; Marriage; Maternal Health; Maternal and Child Health; Measures; Mediating; Mediation; Methodology; Methods; Modeling; Mothers; Nepal; Nulliparity; Outcome; Participant; Pathway interactions; Persons; Pregnancy; Randomized; Randomized, Controlled Trials; Reproductive Health; Reproductive Health Services; Research; Resources; Risk; Running; Services; Support Groups; Surveys; Survival Analysis; Testing; Time; Training; Woman; Work; aged; arm; avoid pregnancy; community organizations; cost; design; economic evaluation; effectiveness evaluation; effectiveness/implementation design; empowerment; evidence base; future implementation; group intervention; health empowerment; health knowledge; high risk; implementation research; improved; information gathering; intervention effect; parity; parous; post intervention; prevent; primary outcome; process evaluation; programs; scale up; sex; skills; skills training; standard of care; success; time-to-pregnancy; unintended pregnancy; young woman

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.

项目总结