title: Measuring What Works: An Impact Evaluation of Women's Groups on Maternal Health Uptake in Rural Nepal.
abstract: There is a need for studies evaluating maternal health interventions in low-income countries. This paper evaluates one such intervention designed to promote maternal health among rural women in Nepal.
  
  
  
  This was a five-year controlled, non-randomised, repeated cross-sectional study (2007, 2010, 2012) of a participatory community-based maternal health promotion intervention focusing on women's groups to improve maternal health services uptake. In total 1,236 women of childbearing age, who had their last child ≤ two years ago, were interviewed. Difference-in-Difference estimation assessed the effects of the intervention on selected outcome variables while controlling for a constructed wealth index and women's characteristics. In the first three years (from 2007 to the 2010), the intervention increased women's likelihood of attending for antenatal care at least once during pregnancy by seven times [OR = 7.0, 95%CI (2.3; 21.4)], of taking iron and folic acid by three times [OR = 3.0, 95%CI (1.2; 7.8)], and of seeking four or more antenatal care visits of two times, although not significantly [OR = 2.2, 95%CI (1.0; 4.7)]. Over five years, women were more likely to seek antenatal care at least once [OR = 3.0, 95%CI (1.5; 5.2)], to take iron/folic acid [OR = 1.9, [95% CI (1.1; 3.2)], and to attend postnatal care [OR = 1.5, [95% CI (1.1; 2.2)]. No improvement was found on attending antenatal care in the first trimester, birthing at an institution or with a skilled birth attendant.
  
  
  
  Community-based health promotion has a much stronger effect on the uptake of antenatal care and less on delivery care. Other factors not easily resolved through health promotion interventions may influence these outcomes, such as costs or geographical constraints. The evaluation has implications for policy and practice in public health, especially maternal health promotion.
authors.affiliation: Faculty of Health and Social Sciences, Bournemouth University, Dorset, United Kingdom.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Faculty of Health and Social Sciences, Bournemouth University, Dorset, United Kingdom.
authors.forename: Edwin van
authors.initials: Ev
authors.lastname: Teijlingen
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: José M
authors.initials: JM
authors.lastname: Belizán
authors.affiliation: Faculty of Health and Social Sciences, Bournemouth University, Dorset, United Kingdom.
authors.forename: Vanora
authors.initials: V
authors.lastname: Hundley
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Liverpool, United Kingdom.
authors.forename: Padam
authors.initials: P
authors.lastname: Simkhada
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.|Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elisa
authors.initials: E
authors.lastname: Sicuri
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D000068097:Maternal Health / Q000592:standards / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D008428:Maternal Mortality; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012657:Self-Help Groups / Q000458:organization & administration; D055815:Young Adult