Evaluation of impact of engaging federations of women groups to improve women’s nutrition interventions- before, during and after pregnancy in social and economically backward geographies: Evidence from three eastern Indian States

Background: Undernutrition–before, during and after pregnancy endangers the health and well-being of the mother and contributes to sub-optimal fetal development and growth. A non-randomized controlled evaluation was undertaken to assess the impact of engaging federations of women’s group on coverage of nutrition interventions and on nutrition status of women in the designated poverty pockets of three Indian states—Bihar, Chhattisgarh, and Odisha. Method: The impact evaluation is based on two rounds of cross-sectional data from 5 resource poor blocks across 3 States, assigning 162 villages to the intervention arm and 151 villages to the control arm. The cross-sectional baseline (2016–17) and endline survey (2021–22) covered a total of 10491 adolescent girls (10–19 years), 4271 pregnant women (15–49 years) and 13521 mothers of children under age two years (15–49 years). Exposure was defined based on participation in the participatory learning and action meetings, and fixed monthly health camps (Adolescent Health Days (AHDs) and Village Health Sanitation and Nutrition Days (VHSNDs)). Logistic regression models were applied to establish the association between exposure to programme activities and improvement in coverage of nutrition interventions and outcomes. Results: In the intervention area at endline, 27–38% of women participated in the participatory learning and action meetings organized by women’s groups. Pregnant women participating in programme activities were two times more likely to receive an antenatal care visit in the first trimester of pregnancy (Odds ratio: 2.55 95% CI-1.68–3.88), while mothers of children under 2 were 60% more likely to receive 4 ANC visits (Odds ratio: 1.61, 95% CI- 1.30–2.02). Odds of consuming a diversified diet was higher among both pregnant women (Odds ratio: 2.05, 95% CI- 1.41–2.99) and mother of children under 2 years of age (Odds ratio: 1.38, 95% CI- 1.08–1.77) among those participating in programme activities in the intervention arm. Access to commodities for WASH including safe sanitation services (Odds ratio: 1.80, 95% CI- 1.38–2.36) and sanitary pads (Odds ratio: 1.64, 95% CI- 1.20–2.22) was higher among adolescent girls participating in programme activities. Conclusion: Women’s groups led participatory learning and action approaches coupled with strengthening of the supply side delivery mechanisms resulted in higher coverage of health and nutrition services. However, we found that frequency of participation was low and there was limited impact on the nutritional outcomes. Therefore, higher frequency of participation in programme activities is recommended to modify behaviour and achieve quick gains in nutritional outcomes.