The impact of group-based life skills and health empowerment for young, married, women to avoid unintended pregnancies in India.

在印度，基于群体的生活技能和健康赋权对年轻、已婚妇女避免意外怀孕的影响。

• 批准号: 10419108
• 负责人: NADIA GRIFFI DIAMOND-SMITH
• 金额: $ 60.3万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10419108
• 关键词: Affect; Asia; Birth; Child; Child Health; Communication; Communities; Community Health Aides; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Cost Effectiveness Analysis; Data; Decision Making; Economics; Enrollment; Family; Female Adolescents; Future; Goals; Health; Health Resources; Health Services; Health education; Household; Household and Family; Husband; India; Infant Health; Intention; Intermediate Variables; Intervention; Interview; Laws; Life; Life Cycle Stages; Marriage; Maternal Health; Maternal and Child Health; Measures; Mediating; Mediation; Methodology; Methods; Modeling; Mothers; Nepal; Nulliparity; Outcome; Participant; Pathway interactions; Persons; Pregnancy; Randomized; Randomized Controlled Trials; Reproductive Health; Reproductive Health Services; Research; Resources; Risk; Running; Services; Support Groups; Surveys; Survival Analysis; Testing; Time; Training; Triad Acrylic Resin; Use Effectiveness; Woman; Work; aged; arm; base; cost; design; economic evaluation; education access; effectiveness evaluation; effectiveness implementation study; empowered; empowerment; evidence base; future implementation; group intervention; health empowerment; health knowledge; high risk; implementation research; improved; intervention effect; parity; parous; post intervention; prevent; primary outcome; process evaluation; programs; scale up; sex; skills; skills training; standard of care; success; time-to-pregnancy; unintended pregnancy; young woman

PROJECT SUMMARY Unintended pregnancies put women at risk of poor maternal and child health outcomes. In India, half of all pregnancies are unintended and younger women have the highest risk of having an unmet need for contraception. New evidence suggests that young, newly married women in this setting desire to postpone pregnancy, yet have low use of contraception and high rates of unintended pregnancy, and desire reproductive health knowledge. Young women in India also have low empowerment, and desire training in life skills that could be used to help them gain status and opportunity in their households and communities. Few rigorously designed and tested interventions have focused on women’s empowerment (including life skills and health- related) and unintended pregnancy, especially among young, married women in India. This proposal tests the impact of a combined life skills and health empowerment intervention for young married women on avoiding unintended pregnancy, and other health and empowerment outcomes. The intervention, DAMINI, is currently on-going in villages in Uttar Pradesh, India, and the goal of this proposal is to conduct a two-arm randomized cluster study of (1) DAMINI (life skills and health empowerment); and (2) the standard of care health education and access to contraceptives provided by community health workers. This approach will focus on recently married women aged 18-25 years who are at risk of pregnancy but do not want a pregnancy at the time of enrollment and will follow them for two years post-intervention through in-person surveys. DAMINI is delivered in groups and we will work in 40 intervention and 40 control village clusters; with 1 group per cluster and 6-7 women in each cluster/group (total N=520). We will also collect longitudinal triadic in-depth interviews with newly married women, their husbands, and mothers-in-law to understand changing norms and pathways of impact. The first aim is to determine the effectiveness of DAMINI on the risk of having an unintended pregnancy, compared to health education alone. Survival analysis of time to pregnancy (primary outcome) will be used to analyze the impact on unintended pregnancy. Given potentially different factors affecting parous vs. nulliparous women, we will model the effect of DAMINI on them separately, and include parity specific measures such as sex of previous births and duration since marriage.The second aim is to assess the effectiveness of DAMINI on intermediary outcomes related to life skills and health empowerment, compared to health education alone, using the same methodological approach. Finally, to inform future implementation research, we will use an effectiveness-implementation hybrid design to conduct a mixed methods process evaluation with participants and their households and DAMINI and community leaders. This will also include an economic evaluation, specifically a cost effectiveness analysis. If proven effective, it is anticipated that this intervention could be integrated into existing self help groups and scaled up in India (and other parts of South Asia) to improve women and children’s health, long-term economic and empowerment related outcomes.

项目摘要 意外怀孕使妇女面临较差的遗物和儿童健康结果的风险。在印度，一半 怀孕是意外的，年轻女性的风险最高 避孕。新证据表明，在这种环境中，年轻，新婚的妇女推迟了 怀孕，但避孕和高率的使用率很低，并且渴望复制品 健康知识。印度的年轻妇女的赋权也很低，并且渴望在生活技能方面的培训 可以用来帮助他们在家庭和社区中获得地位和机会。很少有 设计和测试的干预措施集中在妇女的赋权上（包括生活技能和健康 - 相关）和意外怀孕，尤其是在印度的年轻妇女中。该建议测试 与年轻妇女避免的生活技能和健康赋权干预的联合影响 意外怀孕以及其他健康和赋权结果。干预措施，达米尼（Damini）目前 印度北方邦的村庄正在进行，该提议的目标是进行两臂随机 （1）Damini（生命技能和赋予健康能力）的集群研究； （2）护理健康教育的标准 并使用社区卫生工作者提供的避孕药具。这种方法将最近关注 已婚妇女18-25岁的妇女有怀孕风险，但不希望在 入学率，并将通过面对面调查进行两年干预后进行。达米尼被交付 分组，我们将进行40个干预和40个控制村集群的工作；每个集群1组和6-7 每个集群/组中的女性（总n = 520）。我们还将收集与 新婚妇女，丈夫和岳母，以了解不断变化的规范和道路 影响。第一个目的是确定达米尼对有意外的风险的有效性 与仅健康教育相比，怀孕。怀孕时间的生存分析（主要结果）将 用于分析对意外怀孕的影响。鉴于影响Parous vs的潜在不同因素。 无效的女性，我们将分别建模达米尼对她们的影响，并包括特定于奇偶校验 诸如结婚以来先前出生和持续时间之类的措施。第二个目的是评估 Damini对与生活技能和赋权有关的中级结果的有效性，与 仅使用相同的方法论方法，仅健康教育。最后，告知未来实施 研究，我们将使用有效性实施混合设计来进行混合方法过程 与参与者及其家庭以及达米尼和社区领导人进行评估。这也将包括一个 经济评估，特别是成本效益分析。如果被证明有效，可以预期 干预措施可以集成到现有的自助小组中，并在印度（以及南方的其他地区）扩大规模 亚洲）为了改善妇女和儿童的健康，长期经济和赋权相关的结果。