Nossal Institute for Global Health, The University of Melbourne, Level 4, Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3010, Australia.
Int J Equity Health. 2013 May 28;12:36. doi: 10.1186/1475-9276-12-36.
The main challenge for achieving universal health coverage in India is ensuring effective coverage of poor and vulnerable communities in the face of high levels of income and gender inequity in access to health care. Drawing on the social capital generated through women's participation in community organizations like SHGs can influence health outcomes. To date, evidence about the impact of SHGs on health outcomes has been derived from pilot-level interventions, some using randomised controlled trials and other rigorous methods. While the evidence from these studies is convincing, our study is the first to analyse the impact of SHGs at national level.
We analyzed the entire dataset from the third national District Level Household Survey from 601 districts in India to assess the impact of the presence of SHGs on maternal health service uptake. The primary predictor variable was presence of a SHG in the village. The outcome variables were: institutional delivery; feeding newborns colostrum; knowledge about family planning methods; and ever used family planning. We controlled for respondent education, wealth, heard or seen health messages, availability of health facilities and the existence of a village health and sanitation committee.
Stepwise logistic regression shows respondents from villages with a SHG were 19 per cent (OR: 1.19, CI: 1.13-1.24) more likely to have delivered in an institution, 8 per cent (OR: 1.08, CI: 1.05-1.14) more likely to have fed newborns colostrum, have knowledge (OR: 1.48, CI 1.39 - 1.57) and utilized (OR: 1.19, CI 1.11 - 1.27) family planning products and services. These results are significant after controlling for individual and village-level heterogeneities and are consistent with existing literature that the social capital generated through women's participation in SHGs influences health outcome.
The study concludes that the presence of SHGs in a village is associated with higher knowledge of family planning and maternal health service uptake in rural India. To achieve the goal of improving public health nationally, there is a need to understand more fully the benefits of systematic collaboration between the public health community and these grassroots organizations.
在印度实现全民健康覆盖的主要挑战是确保贫困和弱势群体能够有效获得医疗服务，尽管印度在获取医疗服务方面存在着较高的收入和性别不平等问题。利用妇女参与妇女自助团体等社区组织所产生的社会资本可以影响健康结果。迄今为止，关于自助团体对健康结果影响的证据来自试点干预措施，其中一些使用了随机对照试验和其他严格的方法。虽然这些研究的证据令人信服，但我们的研究是第一个在国家层面分析自助团体影响的研究。
我们分析了来自印度 601 个地区的第三次全国地区家庭调查的全部数据集，以评估村庄中自助团体的存在对产妇保健服务利用率的影响。主要预测变量是村庄中是否存在自助团体。结果变量是：机构分娩；新生儿喂养初乳；对计划生育方法的了解；以及是否使用计划生育。我们控制了受访者的教育程度、财富、是否听说过卫生信息、卫生设施的可及性以及村庄卫生和环境卫生委员会的存在。
逐步逻辑回归显示，来自有自助团体的村庄的受访者更有可能在机构分娩（OR：1.19，CI：1.13-1.24），更有可能给新生儿喂养初乳（OR：1.08，CI：1.05-1.14），更有可能了解（OR：1.48，CI 1.39-1.57）和使用（OR：1.19，CI 1.11-1.27）计划生育产品和服务。在控制个人和村庄层面的异质性后，这些结果具有统计学意义，与现有的文献一致，即妇女参与自助团体产生的社会资本会影响健康结果。
本研究得出结论，村庄中存在自助团体与印度农村地区更高的计划生育知识和产妇保健服务利用率有关。为了实现提高全国公共卫生水平的目标，需要更全面地了解公共卫生界与这些基层组织之间系统合作的好处。
