The Effect of Self Help Groups on Access to Maternal Health Services: Evidence from Rural India

Abstract

Background: The main challenge for achieving universal health coverage in India is ensuring effective coverage for poor and vulnerable communities, with high levels of income and gender inequity in access to health care. Self help groups (SHGs), a small economically homogeneous affinity group of the rural poor voluntarily coming together to save small amount and provide collateral free loans, is considered the cornerstone of much of the microfinance activity. SHGs are perceived to influence health outcome, particularly maternal and child health knowledge and service utilization. Evidence about the impact of SHGs on health has, however, have been derived from pilot level interventions and is thus limited in scope. Widening this scope by using data from the national District Level Household Survey (DLHS-3), this paper analyzes the influence of the presence of SHGs on maternal health service uptake in rural India. Methods: DLHS-3 collected information on 643,944 ever married women from 22,825 villages in India. The primary predictor variable was presence of SHG in village. The outcome variables were: institutional delivery; feeding newborns colostrums; knowledge about female sterilization, IUD, oral pills, emergency contraception, and female condom; and ever used oral pills, IUD, and female sterilization. Stepwise logistic regression was applied to estimate the influence controlling for respondent education, occupation, heard or seen health messages, availability of educational facilities, and the existence of a village health and sanitation committee. Results: Respondents from villages with SHG were more likely to have delivered in an institution, feed newborn colostrums, know and utilize family planning products and services. These results are positive and 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 SHG, influence health outcome. Conclusion: 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. Also our results indicates the need for complementary health programmes to build up on the solidarity and social capital generated as a result of the association, to have maximum impact on community health. To achieve the goal of improving public health, there is a need to better understand the benefit of systematic collaboration between public health community and these grassroots organizations.