Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Institute for Financial Management and Research, Leveraging Evidence for Access and Development, Chennai, Tamil Nadu, India.
J Glob Health. 2024 Nov 8;14:04063. doi: 10.7189/jogh.14.04063.
Women in India are often responsible for unpaid household work, family caregiving, and paid work, which can contribute to poorer mental health. The provision of childcare has the potential to improve women's mental health, but evidence on the effects of providing access to daycare is limited.
We designed a cluster-randomised trial and used data from a sample of 2858 mothers with age-eligible children from 160 village hamlets in rural Rajasthan, India, to evaluate the impact of providing access to a community-based daycare programme on social and emotional aspects of women's mental health. We conducted a baseline survey in early 2016, randomised hamlets to intervention or control groups approximately six months later, and delivered the final post-intervention survey approximately two years thereafter.
Treatment assignment increased the probability that a respondent used a daycare over the two-year follow-up by 40.9 percentage points. Providing randomised access to a daycare resulted in 0.2 (95% confidence interval (CI) = -0.1, 0.4) fewer symptoms of mental distress, representing a 9.5% decline compared to the baseline mean of 2.1 symptoms, as well as a 3.7 (95% CI = -0.8, 8.3) percentage point increase in the proportion of women who reported feeling very happy, equivalent to an 11.0% increase relative to the baseline mean of 33.6%. Among social indicators, treatment assignment was associated with a 5.6 (95% CI = -1.2, 12.4) percentage point increase in membership in an association, a relative increase of 43.4% compared to the baseline mean of 12.9%. The intervention did not have an appreciable impact on measures of life satisfaction or trust in institutions. Two-stage least squares instrumental variable analyses showed that daycare use decreased mental distress by 0.4 (95% CI = -0.1, 0.8) symptoms, increased the proportion of women who were very happy by 9.4 (95% CI = 0.0, 17.6) percentage points, and increased membership in an organisation by 15.9 (95% CI = 8.4, 23.7) percentage points.
The provision of affordable, community-based daycare was associated with substantial uptake and showed potential for improving mothers' mental health in a rural context where most women were not employed in the formal labour force.
ISRCTN clinical trial registry (ISRCTN45369145), registered on 16 May 2016; American Economic Association's registry for randomised controlled trials (AEARCTR-0000774), registered on 15 July 2015.
印度女性通常负责无偿家务、家庭护理和有酬工作，这可能导致其心理健康状况较差。提供儿童保育服务有可能改善女性的心理健康，但关于提供日托服务的效果的证据有限。
我们设计了一项整群随机试验，并使用了来自印度拉贾斯坦邦农村 160 个乡村村的 2858 名年龄符合条件的儿童的母亲的样本数据，评估了提供社区基础的日托服务对女性心理健康的社会和情感方面的影响。我们在 2016 年初进行了基线调查，大约六个月后将村随机分配到干预组或对照组，并在两年后进行了最终的干预后调查。
治疗分配使受访者在两年的随访中使用日托的可能性增加了 40.9 个百分点。提供随机的日托服务使心理困扰症状减少了 0.2（95%置信区间[CI]：-0.1，0.4），与基线均值 2.1 个症状相比，下降了 9.5%，而报告非常高兴的女性比例增加了 3.7（95%CI：-0.8，8.3）个百分点，相当于基线均值 33.6%的 11.0%的增长。在社会指标方面，治疗分配与协会成员资格增加 5.6（95%CI：-1.2，12.4）个百分点有关，与基线均值 12.9%相比，相对增加了 43.4%。该干预措施对生活满意度或对机构的信任度没有明显影响。两阶段最小二乘法工具变量分析表明，日托的使用使心理困扰症状减少了 0.4（95%CI：-0.1，0.8）个症状，使非常高兴的女性比例增加了 9.4（95%CI：0.0，17.6）个百分点，使组织成员增加了 15.9（95%CI：8.4，23.7）个百分点。
提供负担得起的社区日托服务与大量使用相关，并显示出在大多数女性没有在正规劳动力市场就业的农村环境中改善母亲心理健康的潜力。
ISRCTN 临床试验注册（ISRCTN45369145），于 2016 年 5 月 16 日注册；美国经济协会随机对照试验登记处（AEARCTR-0000774），于 2015 年 7 月 15 日注册。
