Improving Birth Preparedness and Complication Readiness Through an Integrated Microfinance and Health Literacy Program:Evidence From Rural India

Abstract Background:Despite maternal mortality rate almost halving over the past two decades, approximately 295,000 deaths occurred annually in 2017 globally. They occur in high burden regions where most preventable deaths are precipitated by delays in maternal care provision. Recently, a novel rapidly scalable community-based program combining maternal health literacy delivery through microfinance-based women-only self-help groups (SHG) was implemented in rural India. We evaluated the impact of the IMFHL program on BPCR practice by women in one of India’s poorest states-Uttar Pradesh, adjusting for community, household and individual variables. We also investigated if there is a diffusion of knowledge of BPCR from SHG members receiving the health literacy intervention to non-members in program villages.Method: Using secondary survey data from the IMFHL project, we analysed data from 17,244 women across SHG and non-member households in Uttar Pradesh. We performed multivariable logistic regressions to estimate adjusted IMFHL program’s effects on maternal BPCR practice.Results: Membership in SHG alone is positively associated with BPCR practice with 17 percent higher odds compared to women in villages without the programs. Furthermore, the odds of practising complete BPCR increases by almost fifty percent when a maternal health literacy component is added to the SHGs. A diffusion effect was found for BPCR practice from SHG members to non-members only when an added health literacy component was integrated into the SHG model. The main effect of the IMFHL program on BPCR practice remained stable in the presence of confounders suggesting that the delivery of health messages is undiluted by other non-programmatic factors at the individual, household and community level. Among confounders, only the poorest households as captured by the wealth quintile were significantly negatively associated with BPCR practice.Conclusion: The public health literature promotes the adoption of BPCR practices to improve maternal health outcomes. This study shows that SHGs exert both a dissemination effect of planned health behaviour within members, as well as facilitate a diffusion effect of the natural transfer of BPCR from members to non-members when SHGs are enriched with a health literacy component