title: Formative evaluation of a participatory women's group intervention to improve reproductive and women's health outcomes in rural Bangladesh: a controlled before and after study.
abstract: Women's groups using participatory methods reduced newborn mortality in rural areas of low income countries. Our study assessed a participatory women's group intervention that focused on women's health, nutrition and family planning.
  
  
  
  The study was conducted in three districts in Bangladesh between October 2011 and March 2013, covering a population of around 230 000. On the basis of allocation for the preceding cluster randomised trials, three unions per district were randomly allocated to receive a women's group intervention and three per district were control clusters. Outcomes included unmet need for family planning, morbidity, dietary diversity, night blindness, healthcare decision-making and knowledge of sexual and reproductive health, nutrition and anaemia. A difference-in-difference analysis was used to adjust for secular trends and baseline differences between women taking part in the intervention and a random sample from control clusters.
  
  
  
  We interviewed 5355 (91% response rate) women before the intervention and 5128 after (96% response rate). There were significant improvements in women's dietary diversity score (increase of 0.2 (95% CI 0.1 to 0.3)) and participation in healthcare decision-making (proportion increase (95% CI) 14.0% (10.6% to 17.4%)). There were also increases in knowledge about: contraception (4.2% (2.0% to 6.3%)), ways to treat (55.4% (52.2% to 58.5%)) and prevent (71.0% (68.0% to 74.1%)) sexually transmitted infections, nutrition (46.6% (43.6% to 49.6%)) and anaemia prevention (62.8% (60.9% to 64.6%)). There were no significant differences in unmet need for family planning, morbidity or night blindness.
  
  
  
  Participatory women's groups have considerable potential to improve women's health knowledge, but evidence of impact on certain outcomes is lacking. Further formative work and intervention development is needed to optimise the impact of this approach for women's health.
authors.affiliation: UCL Institute for Global Health, University College London, London, UK.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Harris-Fry
authors.affiliation: Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.affiliation: UCL Institute for Global Health, University College London, London, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Younes
authors.affiliation: Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Abdul
authors.initials: A
authors.lastname: Kuddus
authors.affiliation: Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Sanjit
authors.initials: S
authors.lastname: Shaha
authors.affiliation: Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Tasmin
authors.initials: T
authors.lastname: Nahar
authors.affiliation: Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Munir
authors.initials: M
authors.lastname: Hossen
authors.affiliation: UCL Institute for Global Health, University College London, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: UCL Institute for Global Health, University College London, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
mesh_terms: D000328:Adult; D001459:Bangladesh; D003267:Contraception; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D034121:Reproductive Health Services; D012424:Rural Population; D016387:Women's Health
keywords: DEVELOPING COUNTR; DIET; FAMILY PLANNING; HEALTH BEHAVIOUR; MATERNAL HEALTH