Institute for Global Health, University College London, London, UK.
Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Matern Child Nutr. 2022 Oct;18(4):e13398. doi: 10.1111/mcn.13398. Epub 2022 Jul 19.
A trial of three nutrition-sensitive agriculture interventions with participatory videos and women's group meetings in rural Odisha, India, found improvements in maternal and child dietary diversity, limited effects on agricultural production, and no effects on women and children's nutritional status. Our process evaluation explored fidelity, reach, and mechanisms behind interventions' effects. We also examined how context affected implementation, mechanisms, and outcomes. We used data from intervention monitoring systems, review notes, trial surveys, 32 case studies with families (n = 91 family members), and 20 group discussions with women's group members and intervention workers (n = 181 and 32, respectively). We found that interventions were implemented with high fidelity. Groups reached around half of the mothers of children under 2 years. Videos and meetings increased women's knowledge, motivation and confidence to suggest or make changes to their diets and agricultural production. Families responded in diverse ways. Many adopted or improved rainfed homestead garden cultivation for consumption, which could explain gains in maternal and child dietary diversity seen in the impact evaluation. Cultivation for income was less common. This was often due to small landholdings, poor access to irrigation and decision-making dominated by men. Interventions helped change norms about heavy work during pregnancy, but young women with little family support still did considerable work. Women's ability to shape cultivation, income and workload decisions was strongly influenced by support from male relatives. Future nutrition-sensitive agriculture interventions could include additional flexibility to address families' land, water, labour and time constraints, as well as actively engage with spouses and in-laws.
在印度奥里萨邦的一个农村地区进行了三项营养敏感型农业干预措施的试验，这些措施包括参与式视频和妇女小组会议，结果发现这些干预措施改善了孕产妇和儿童的饮食多样性，但对农业生产的影响有限，对妇女和儿童的营养状况没有影响。我们的过程评估探讨了干预措施效果背后的保真度、覆盖范围和机制。我们还研究了背景如何影响实施、机制和结果。我们使用了干预监测系统的数据、审查记录、试验调查、32 个家庭的案例研究（n=91 个家庭成员）以及 20 个妇女小组和干预工作者的小组讨论（n=181 和 32）的数据。我们发现干预措施的实施具有高度的保真度。小组接触到了大约一半 2 岁以下儿童的母亲。视频和会议提高了妇女的知识、动力和信心，使她们能够提出或改变饮食和农业生产。家庭以不同的方式做出了回应。许多家庭采用或改进了雨养家庭园的种植方式，用于自给自足，这可以解释在影响评估中看到的孕产妇和儿童饮食多样性的增加。为收入而种植的情况则比较少见。这通常是由于土地面积小、灌溉条件差以及决策权主要由男性主导。这些干预措施有助于改变关于怀孕期间繁重工作的规范，但缺乏家庭支持的年轻女性仍然承担了大量工作。妇女在种植、收入和工作量决策方面的能力受到男性亲属支持的强烈影响。未来的营养敏感型农业干预措施可以增加灵活性，以解决家庭的土地、水、劳动力和时间限制问题，并积极与配偶和姻亲接触。
