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Study Overview

Title:
Women Improving Nutrition through Group-based Strategies (WINGS) : Building evidence on how self-help groups/women’s groups in India can improve nutrition outcomes through integrated programming
Study is 3ie funded:
No
Study ID:
RIDIE-STUDY-ID-5d567e7e8b967
Initial Registration Date:
08/16/2019
Last Update Date:
08/08/2019
Study Status:
Ongoing
Location(s):
India
Abstract:

The proposed study will address key evidence gaps on the impact of using Self Help Groups (SHGs) as a platform to improve agricultural practices, nutrition outcomes and women’s empowerment in the Indian context. We seek to identify how the provision of health and nutrition social and behavior change communication (SBCC) through SHGs affects the diet and nutritional status of women and young children. In addition, we study the impact both of participating in SHGs and the provision of this SBCC on a number of secondary outcomes, including knowledge and practices related to the underlying determinants of nutrition, women’s empowerment in agriculture, the demand for and use of public entitlement programs, and agricultural practices, among others. In doing this, we hope to develop a generalizable framework for the pathways to impact from SHG membership to improved health and nutrition outcomes for mothers and young children.

Categories:
Agriculture and Rural Development
Health, Nutrition, and Population
Multisector
Other
Additional Keywords:
Gender, women's empowerment, maternal nutrition, child nutrition, India
Secondary ID Number(s):
OPP1132181

Principal Investigator(s)

Name of First PI:
Neha Kumar
Affiliation:
IFPRI
Name of Second PI:
Agnes Quisumbing
Affiliation:
IFPRI

Study Sponsor

Name:
Bill & Melinda Gates Foundation
Study Sponsor Location:
United States

Research Partner

Name of Partner Institution:
None
Type of Organization:
Location:
United States
Intervention

Intervention Overview

Intervention:

The intervention is implemented by Professional Assistance for Development Action, PRADAN, an Indian NGO that works with women’s self-help groups (SHGs) to promote economically viable and sustainable agriculture and other livelihood practices and implement a number of other interventions to promote adult functional literacy, water & sanitation, gender equality and access to entitlements. Under the intervention that is being evaluated in this study, PRADAN is testing the ability of SHGs to address nutrition through a multi strategy approach that combines the thematic areas of gender, agriculture, social mobilization and nutrition/health. Nutrition intensive SBCC messages have been developed by the Public Health Resource Netweork (PHRN) and will be delivered using the SHG platform. The objective is to improve the health and nutrition status of women and children across intervention sites in 8 districts – Dindori and Mandla in MP; Bastar in Chhattisgarh; Dumka and West Singbhum in Jharkhand; Purulia in West Bengal; and Kandhamal and Rayagada in Odisha. The direct beneficiaries are women SHG members and their children.

Theory of Change:

Women’s participation in SHGs can improve women and children’s nutritional status through 4 distinct pathways: 1) generation of income through savings and credit activities to improve purchasing power (the income pathway), 2) engagement of women to improve agricultural livelihoods (the agriculture pathway), 3) building social accountability and community demand for government entitlement programs that may improve nutritional outcomes (the rights pathway) and 4) social and behavior change communication (SBCC) to improve health and nutrition awareness and knowledge (the health and nutrition behavior change pathway). In addition to these four, building social capital, taking collective action and promoting women’s empowerment are three cross-cutting pathways that affect all others.

The nutrition intensification intervention will leverage PRADANs existing presence and engagement with women’s groups. Through the provision of health and nutrition SBCC, it will aim to improve understanding of the underlying causes and practices related to undernutrition and health and identify actions at various levels to improve nutrition. In addition, since it is layered onto the standard PRADAN model, it also has the potential to trigger all the other pathways outlined above. This means the package of interventions being proposed could improve overall health and nutrition-related knowledge, infant and young child feeding practices, hygiene and sanitation practices, household food security, women’s empowerment in agriculture, agriculture and livestock practices in households, and uptake of welfare schemes that affect health and nutrition of women and children, among other outcomes, ultimately resulting in a positive impact on women’s BMI, children’s anthropometrics and household dietary diversity.

Multiple Treatment Arms Evaluated?
Yes

Implementing Agency

Name of Organization:
Professional Assistance for Development Action (PRADAN) and Public Health Resource Network (PHRN).
Type of Organization:
NGO (local)/Community Based Organization/Other civil society organization

Intervention Timing

Intervention or Program Started at time of Registration?
Yes
Start Date:
01/01/2016
End Date:
09/30/2019
Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Matching
Other (not Listed) Method:
Additional Evaluation Method (If Any):
Difference in difference/fixed effects
Other (not Listed) Method:

Method Details

Details of Evaluation Approach:

The impact evaluation is based on a quasi-experimental design. In each of the 8 districts that are part of the evaluation, three blocks are selected. One belongs to the nutrition-intensification PRADAN arm, one to the standard PRADAN arm, and one to a comparison arm with no PRADAN presence that is matched to the two intervention arms based on block and village-level characteristics. The impact evaluation will be based on a matched difference-in-difference approach using two rounds of quantitative household-level panel data as well as two rounds of cross-section data. The matching at the block and village level was conducted using information on various development indices and in consultation with PRADAN. The purpose of this matching exercise was to reduce variability across selected intervention sites and maximize potential for attribution of impact to PRADAN’s standard and nutrition-intensification models, while at the same time respecting PRADAN’s decision to not randomize. Where two or more blocks were equally good matches, PRADAN suggested the choice of the best match, based on knowledge of the local contexts. In addition, at the time of analysis, we will further match individuals across arms based on their socioeconomic and demographic characteristics.

Outcomes (Endpoints):

Primary outcomes

  1. Women’s body mass index (BMI)
  2. Women’s dietary diversity (DD), measured using a food-group based diet diversity index (DD)

 

Secondary outcomes

Women

  1. Empowerment in agriculture, measured using the women’s empowerment in agriculture index
  2. Aspirations (e.g. financial, social)
  3. Knowledge and practices in health, nutrition, agriculture, and water, sanitation and hygiene (WASH)

Children

  1. Anthropometric z-scores (<5y): HAZ, WHZ, WAZ
  2. Dietary diversity
  3. Infant and young child feeding (IYCF) practices (<2y)

Households

  1. Food security, measured using the Household Food Insecurity Access Scale (HFIAS)
Unit of Analysis:
Ever-married women in the age group 15-49 years old.
Hypotheses:

The agriculture and livelihoods focus of the PRADAN intervention can improve the agricultural planning of SHG members through training on farming practices, new crops and nutrition-sensitive agriculture. Improved livelihoods practices are intended to improve nutritional indicators through income and production-consumption pathways. At the same time providing information on services and social protection schemes available to SHG members could increase awareness and uptake of health and nutrition welfare schemes and improve nutritional indicators. The gender and women’s empowerment component increases gender-related nutrition knowledge that could ultimately lead to equal allocation of resources between men and women and improve the uptake of diverse food to women and children. Finally, by providing health and nutrition BCC to SHG members we would see improved health and nutrition practices including hygiene practices and the purchase and consumption of diverse foods -both of which increase nutrient absorption. Finally, improvements in some or all of these intermediate outcomes will drive ultimate improvement in women’s BMI and child anthropometry.

Unit of Intervention or Assignment:
The intervention is being received at the block level
Number of Clusters in Sample:
24
Number of Individuals in Sample:
2720
Size of Treatment, Control, or Comparison Subsamples:
This intervention has 3 arms each with 8 clusters (blocks), Nutrition intensive arm has 810, Standard arm has 807 and comparison arm has 1127 households.

Supplementary Files

Analysis Plan:
Other Documents:
Data

Outcomes Data

Description:
The impact evaluation will be based on a panel survey of ever-married women of reproductive age (15-49 years) in sampled blocks, some of whom are mothers with young children (<2 years). These surveys will be done three times – at baseline in 2015, a midline in 2017 and an endline survey in 2019. We will also collect a cross sectional survey at midline and endline to identify impacts on nutrition knowledge and practices related to infant and young children (<2 years).
Data Already Collected?
No
Data Previously Used?
Data Access:
Data Obtained by the Study Researchers?
Data Approval Process:
Approval Status:

Treatment Assignment Data

Participation or Assignment Information:
Yes
Description:
Data Obtained by the Study Researchers?
Data Previously Used?
Data Access:
Data Obtained by the Study Researchers?
Data Approval Process:
Approval Status:

Data Analysis

Data Analysis Status:

Study Materials

Upload Study Materials:

Registration Category

Registration Category:
Prospective, Category 1: Data for measuring impacts have not been collected
Completion

Completion Overview

Intervention Completion Date:
Data Collection Completion Date:
Unit of Analysis:
Clusters in Final Sample:
Total Observations in Final Sample:
Size of Treatment, Control, or Comparison Subsamples:

Findings

Preliminary Report:
Preliminary Report URL:
Summary of Findings:
Paper:
Paper Summary:
Paper Citation:

Data Availability

Data Availability (Primary Data):
Date of Data Availability:
Data URL or Contact:
Access procedure:

Other Materials

Survey:
Survey Instrument Links or Contact:
Program Files:
Program Files Links or Contact:
External Link:
External Link Description:
Description of Changes:

Study Stopped

Date:
Reason: