Abstract
BackgroundMaternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. While health system reforms in India prioritised institutional deliveries, inadequate antenatal and postnatal services limit the knowledge of danger signs of obstetric complications to women, which delays the recognition of complications and seeking appropriate health care. 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. This study evaluates the impact of the integrated microfinance and health literacy (IMFHL) program on the knowledge of maternal danger signs in marginalised women from one of India’s most populated and poorer states - Uttar Pradesh. Additionally, the study evaluates the presence of a diffusion effect of the knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages.MethodsSecondary data from the IMFHL program comprising 17,232 women from SHG and non-member households in rural Uttar Pradesh was included. Multivariate logistic regression models were used to identify the program’s effects on the knowledge of maternal danger signs adjusting for a comprehensive range of confounders at the individual, household, and community level.ResultsSHG member women receiving health literacy were 27% more likely to know all danger signs as compared with SHG members only. Moreover, the results showed that the SHG network facilitates diffusion of knowledge of maternal danger signs from SHG members receiving health literacy to non-members in program villages. The study found that the magnitude of the program impact on outcome remained stable even after controlling for other confounding effects suggesting that the health message delivered through the program reaches all women uniformly irrespective of their socioeconomic and health system characteristics.ConclusionsThe findings can guide community health programs and policy that seek to impact maternal health outcomes in low resource settings by demonstrating the differential impact of SHG alone and SHG plus health literacy on maternal danger sign knowledge.
Highlights
Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications
This research aims to evaluate if membership in an integrated microfinance and health literacy (IMFHL) program improves the knowledge levels of maternal danger signs associated with high-risk pregnancies among women in rural Uttar Pradesh while adjusting for other individual, households and community or arealevel characteristics
The results showed that women from households that received health intervention through self-help groups (SHG) had 2.14 times higher odds of knowing maternal danger signs in survey round II compared to the same household type in the round I when the health intervention was yet to start (OR = 2.14, 95%Confidence intervals (CI):1.73–2.65, p < 0.01)
Summary
Maternal mortality can be prevented in low-income settings through early health care seeking during maternity complications. Estimates from key studies suggested that despite the 39% reduction in maternal mortality ratio (MMR) over the MDG period, almost 295,000 maternal deaths still occurred annually in 2017 with the majority disproportionately situated in Africa and South Asia [2]. Reducing maternal mortality in high burden regions requires addressing preventable causes of maternal mortality that may occur at any stage of maternity requiring high-quality person-centred care [4, 5]. These often manifest in pregnant women through physical signs related to underlying pregnancy-related complications, namely bleeding disorders, pregnancy-induced hypertension (eclampsia), delivery complications, post-delivery bleeding and infections [4, 6]. Achieving the maternal health SDG target would require novel strategies that complement existing country-level efforts, especially among low resource and high disease burden regions where substantial maternal deaths are avoidable [1, 4]
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