Combining Economic and Social Empowerment for Family Health Impact:

The Parivartan Experience

Judy Lewis, Board Chair, CORE Group

Karen LeBan, Executive Director, CORE Group

Tom Davis, Chief Program Officer Feed the Children

Janine Schooley, Sr. VP for Programs, PCI

Dennis Cherian, Sr. Director of Health, HIV and AIDS, World Vision, Inc.

36 new blocks

Gaya

Patna

Jamui

Rohtas

Purnia

KaimurBanka

Araria

Saran

Katihar

Siwan

SupaulMadhubani

Nawada

ChamparanWest

BhojpurBuxar

Nalanda

Muzaffarpur

Bhagalpur

Aurangaabad

Sitamarhi

Vaishali

Darbhanga

ChamparanEast

Samastipur

Gopalganj

Saharsa

Begusarai

Munger

Khagaria

Madhepura

Kishanganj

ArwalLakhisaraiJehanabad

Sheikhpura

Sheohar

Parivartan Scale of Operations100 Resource Blocks of Bihar, India

District Blocks

Muzzaffarpur 10

Nalanda 18

Nawada 8

3 36

64 current blocks in 8 districts

Women as change agent at family and community

level, not just the passive

recipients of information and services

Economic and social

empowerment

Facilitation of social advocacy at

family and com-munity level

Groups for MCHN and sanitation behaviors

Improve family health

accountability and equity of

health and sanitation services

IFHIsupply side

intervention

SDPmass and

mid media demand side intervention

1

2

3

4

6

5

7

Parivartan’s Theory of Change

District Block GroupsTranstioned to

Jeevika by Parivartan

Existing Jeevika groups

Sahelis MembersGr Leader Meetings

Begusarai 11 2,176 2,176 0 321 27,417 277

East Champaran

12 3,704 3,704 0 446 48,207 311

Gopalganj 5 1,627 1,627 0 400 20,986

Khagaria 5 6,026 383 5,643 288 67,295 44

Saharsa 10 5,584 2,570 3,014 453 63,523 199

Samastipur 10 3,609 3,609 0 426 48,878 60

West Champaran

8 3,145 3,145 0 380 42,152 145

Patna 3 432 432 15 5,192 0

Total 64 26,303 17,214 9,089 2,729 323,650 1,036

Parivartan Target Population

In 2014, the Population Council led Parivartan’sMid-term Evaluation, focused on capturing family health, sanitation and collective action outcomes for participating most marginalized women in Bihar, India

Methodology

Baseline Midline Endline

1 year 1 year1 year

2013 2014 2015

Design

Hybrid: Longitudinal and cross-sectional surveys of groups

Hybrid: Quantitative and qualitative methods

Cross-sectional survey of women from the selected groups

Sampling design in baseline

Two-stage cluster random sampling (stage-1: blocks; stage-2: community groups)

All eligible* women from each of the selected community groups (approx. 3 women)

Data

Structured survey interviews with eligible* women from community groups

Structured survey interviews with community group leaders

Semi-structured interviews with key informants

Focus group discussions with program personnel (Community Mobilizers)

Used sub-sample of most marginalized women from Ananya survey data

as comparison group

* 18-49 years, currently married, have < 1 year old child

Sample sizeSample Sizes Baseline Baseline

(ex.Patna)

Midline

(ex. Patna)

Number of districts 8 7 7

Number of blocks 35 29(S+H: 23; S: 6)

41(S+H: 23; S: 6)

Number of groups (Cross-sectional data) 732 635 1027

Number of women 2407 2124(S+H: 1523; S: 601)

2237(S+H: 1653; S: 584)

Number of groups (Panel data) 545 545

Analytical sample: Number of women

belonging to common groups

1539(S+H: 1095; S: 444)

937(S+H: 720; S: 217)

Analytical sample: Number of non-SHG

women (most marginalized) from Parivartan

program blocks (Ananya midline sub-sample)

363

(non-SHG women)

S+H: SHG with structured health layered interventionS: SHG without structured health interventionNon-SHG: Most marginalized women not from the groups but from program blocks (Ananya midline sub-sample)

ResultsComparison of non-SHG women with SHG+health

& SHG only Women –Midline only

Women from SHG groups in general showed better results than from the

women in general population. Outcomes are better in case of women from

SHG+Health groups

32

14 13

4238

61

35

21

13

54

43

65

43

31

19

60 58

78

0

20

40

60

80

100

At least 3

or more ANC visits**

Received 90+ IFA

tablets***

Consumed 90+ IFA

tablets*

Received food from

anganwadi center***

Made preparations for

facility delivery***

Received MNCHS

information from

FLW***

Pe

rce

nt

Non-SHG SHG only SHG+Health

SHG+Health : 1653 SHG only:584 Non-group: 363

Regression adj: Referent –non-grp; *** (p<.001); ** (p<.01); * (p<.05); adjusted for age, education, occupation, caste/religion, parity

Maternal Health

Women from SHG groups in general showed better results than from the

women in general population. Outcomes are better in case of women from

SHG+Health groups

53

40

7571

40

14

61

5155

76

65

34

73

64

72

85

66

40

0

20

40

60

80

100

Clean cord care

(nothing applied)***

Skin-to-skin care*** Delayed bath by 24

hours

Breastfed within 1 hour

of birth***

Age-appropriate

immunization***

Visited by FLW within 2

days after delivery***

Pe

rce

nt

Non-SHG SHG only SHG+Health

SHG+Health : 1653 SHG only:584 Non-group: 363

Regression adj: Referent –non-grp; *** (p<.001); ** (p<.01); * (p<.05); adjusted for age, education, occupation, caste/religion, parity

Newborn Care and Childhood Immunization

20 18

9

2520

4

36

27

14

0

20

40

60

80

100

Current use of family planning method*** Current use of modern contraceptive

methods***

Current use of modern spacing method***

Pe

rce

nt

Non-SHG SHG only SHG+Health

Sample sizes (6-11 months): SHG+Health : 1117 SHG only: 401 Non-group: 124

SHG +Health women reported significantly higher family

planning practice

Family Planning Use (mothers with 6-11 months children)

Regression adj: Referent –non-grp; *** (p<.001); ** (p<.01); * (p<.05); adjusted for age, education, occupation, caste/religion, parity

More verbal violence reported by women from SHG groups, however,

physical violence was reported more by the women from non-groups

19

55

17

3742

17

4147

19

0

20

40

60

80

100

Verbal violence*** Physical violence** Sexual violence (ns)

non-SHG SHG only SHG+Health

36

49

19

43 44

1924

33

14

0

20

40

60

80

100

Verbal violence (ns) Physical violence*** Sexual violence (ns)

<= 12 months 13-24 months 25+ months (all women from SHG only groups)

Women’s longer duration of SHG membership is significantly

associated with lesser violence (verbal, physical and sexual)

Length of SHG membership and violence

Regression adj: Referent –non-grp; *** (p<.001); ** (p<.01); * (p<.05); Adjusted for women’s age, education, occupation, household caste, number of children ever born

Regression adj: Referent –<= 12 months; *** (p<.001); ** (p<.01); * (p<.05); Adjusted for women’s age, education, occupation, household caste, number of children ever born

All indicators - experience of violence in the last 12 months

Unpacking the Process of Transformation

Community group members support for MNCHS issues has increased

significantly in case of SHG+Health groups

Source: Parivartan Midline; Notes: Impact (DID method) - */**/***=adjusted difference significant at the 10/5/1 percent level. ns – not significant

Chi-sq test for association between outcome indicators and time within each group. */**/***=significant at the 10/5/1 percent level

5

1830 34

9

0

20

40

60

80

100

SHG+Health SHG only Impact (adj

difference)**

Accompanied by SHG member on at

least one ANC visit

*** ***

7

35

5348

33

0

20

40

60

80

100

SHG+Health SHG only Impact (adj

difference)***

Visited by a community group member

within 2 days after delivery

******

13

30

68

4046

0

20

40

60

80

100

SHG+H SHG only Impact (adj

difference)***

Received MNCHS information from

community group members

*****

8

35

52

35 40

0

20

40

60

80

100

SHG+H SHG only Impact (adj

difference)***

Discussed delivery plans with an SHG

member

*** ns

Baseline Midline

Change in collective and self efficacy measures

39

525651

19

0

20

40

60

80

100

SHG+Health SHG only Impact (adj

difference)***

% r

ep

ort

ing

hig

h c

olle

cti

ve

eff

ica

cy

Collective efficacy increased significantly

for SHG+Health groups

*** ns

283633

43

-2

-10

10

30

50

70

90

SHG+Health SHG only Impact (adj

difference)

% r

ep

ort

ing

hig

h C

A

Marginal increase in collective action -

both the group types

*ns

13 148

16

-6

-10

10

30

50

70

90

SHG+Health SHG only Impact (adj

difference)

% r

ep

ort

ing

hig

h C

A

Very little change in collective

agency

**ns

2822

4032

2

0

20

40

60

80

100

SHG+Health SHG only Impact (adj

difference)

% r

ep

ort

ing

hig

h S

E

Significant increase in self-efficacy for both

group types

*** **

3 4712

-5

-10

10

30

50

70

90

SHG+Health SHG only Impact (adj

difference)**% r

ep

ort

ing

hig

h i

nd

iviu

da

l a

ge

ncy

Marginal increase in individual agency

*** **

Statistical significance test: Change over time the key outcome indicators – Chi sq; Adjusted difference in difference

analyses – DID method. *** p<.01; ** p<.05; * p<.1

Regression model adjusted for age, education, occupation, caste/religion, parityBaseline Midline

Where Are We Going From Here?• Scale-up and Sustainability• Parivartan and the broader

Women Empowered Initiative• Wealth generation pathways• Efficacy generation pathways• Measurement: Overcoming the

challenges of measuring the hard to measure (social impacts) and understanding the hard to understand (what really contributes to real and lasting change, or transformation?)

• The “transformometer” idea

Questions or Comments?

jschooley@pciglobal.org