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Field
Trial Title
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Before
The role of family members and social norms in the demand for maternal health services: Evidence from a field experiment in India
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After
The role of the mother-in-law in the demand for maternal health services: Evidence from a field experiment in India
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Field
Abstract
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Before
The importance of health information targeting and the role of peers is being increasingly studied in low-and middle income countries. In traditional societies like those of rural India, women continue to have limited agency over their own health and decision making due to restrictive social norms often imposed by family members such as the mother-in-law which makes information targeting difficult. In this proposal, we propose a field experiment in the central Indian state of Madhya Pradesh to explore the role of inter-generational bargaining and communication within the household in order to improve the access of young married women in rural India to family planning and maternal health services. Our preliminary findings suggest that young women are unsure about good reproductive health practices and rely heavily on their mothers or mothers-in-law, who in turn rely on traditional knowledge. With this in mind, we propose to randomize whether health information is given to daughters-in-law, mothers-in-law, or both. Further to understand the role of the community and peers in upholding traditional practices, we propose to cross-randomize whether the treatment of giving information to households is made common knowledge or not.
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After
The importance of health information targeting and the role of peers is being increasingly studied in low-and middle-income countries. In traditional societies like those of rural India, women continue to have limited agency over their health and decision-making due to restrictive social norms often imposed by family members such as the mother-in-law, which makes information targeting difficult. In this proposal, we propose a field experiment in the central Indian state of Madhya Pradesh to explore the role of inter-generational bargaining and communication within the household to improve the access of young married women in rural India to family planning and maternal health services. Our preliminary findings suggest that young women are unsure about good reproductive health practices and rely heavily on their mothers or mothers-in-law, who in turn rely on traditional knowledge. With this in mind, we propose randomizing whether health information is given to daughters-in-law (DIL) or mothers-in-law (MIL) and daughters-in-law in a household. Further, to understand the role of the community and peers in upholding traditional practices, we propose two more treatment arms where the information is given to DILs and MILs in groups of either only DILs or a mixed group of DILs and MILs.
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Trial End Date
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Before
August 31, 2022
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After
May 01, 2023
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Field
Last Published
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Before
August 19, 2021 11:11 AM
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After
August 30, 2022 02:40 PM
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Intervention (Public)
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Before
We will conduct the baseline survey with pregnant women and their mothers-in-law. Then each household will be randomly assigned to either a control group or one of three treatment arms: 1) info to Daughter-in-law, 2) info to Mother-in-law. Further, each treatment will be cross randomized into one of two treatment arms: 1) common knowledge, 2) no common knowledge. Depending upon the treatment, the pregnant woman or her mother-in-law or both will receive training on the importance of antenatal care and institutional delivery, as well as healthy practices during and after pregnancy. In addition, all treatment households will also recevie text message reminders for timely antenatal care visits.
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After
We will conduct a baseline survey with pregnant women and their mothers-in-law. The randomization will be conducted in two steps: 1) villages will be randomly assigned to either a control group or one of two treatment arms: 1) group intervention (info is common knowledge), 2) individual intervention (info is not common knowledge). Further, households in each village in each treatment will be then randomized into one of two treatment arms: 1) information to the daughter-in-law; 2) information to the daughter-in-law and the mother-in-law together. The information would be on the importance of antenatal care and institutional delivery, as well as healthy practices during and after pregnancy. In addition, all treatment households will also receive a phone call reminder reinforcing this message.
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Intervention Start Date
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Before
October 01, 2021
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After
March 01, 2022
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Intervention End Date
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Before
December 31, 2021
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After
January 01, 2023
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Primary Outcomes (End Points)
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Before
Maternal health outcomes: Number of antenatal care visits, institutional delivery
Knowledge and belief outcomes: knowledge on the benefits of antenatal care, beliefs related to the consumption of iron folic acid tablets, attitude towards demand for maternal health services
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After
Maternal health outcomes: Number of antenatal care visits, consumption of iron and folic acid tablets
Knowledge and belief outcomes: knowledge of the benefits of antenatal care, beliefs related to the consumption of iron folic acid tablets, attitude towards the demand for maternal health services
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Experimental Design (Public)
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Before
In this study set to launch in Fall 2021, the field team will work with community health workers, the ASHA (Accredited Social Health Activist) to recruit women who are 2-6 months pregnant. A baseline survey will be conducted with the daughter-in-law (DIL) and mother-in-law (MIL) of each participating household, irrespective of treatment. A subset of husbands of the DIL will also be surveyed. We will collect data on background characteristics of the respondents, past pregnancy history, current knowledge and beliefs about maternal health and antenatal care, intra-household decision-making and social networks. We will also collect phone numbers in order to contact the respondents for follow-up surveys.
Once baseline data is collected, villages will be randomized intro treatments. Within two weeks of the baseline, DILs or MILs or both will receive health information regarding the importance of ANC visits and institutional delivery, based on their treatment group. In addition, they will also receive text message reminders for ANC visits.
Finally, we will conduct an endline survey after the date of the delivery of the participating household, on number of ANC visits, knowledge of good maternal health practices, post-delivery outcomes such as beliefs on birth spacing and vaccinations. Survey responses will be complemented by administrative data on maternal and child health.
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After
In this study launched in March 2022, the field team will work with community health workers, the ASHA (Accredited Social Health Activist) to recruit women who are 2-6 months pregnant. A baseline survey will be conducted with the daughter-in-law (DIL) and mother-in-law (MIL) of each participating household, irrespective of treatment. A subset of husbands of the DIL will also be surveyed. We will collect data on background characteristics of the respondents, past pregnancy history, current knowledge and beliefs about maternal health and antenatal care, intra-household decision-making and social networks. We will also collect phone numbers in order to contact the respondents for follow-up surveys.
Once baseline data is collected, villages will be randomized into treatments. Within two weeks of the baseline, DILs or both DILs and MILs will receive health information regarding the importance of ANC visits and institutional delivery, based on their treatment group. In addition, they will also receive information phone call; reminders for ANC visits.
Finally, we will conduct an endline survey after the delivery date of the participating household on a number of ANC visits, knowledge of good maternal health practices, and post-delivery outcomes such as beliefs on birth spacing and vaccinations. Survey responses will be complemented by administrative data on maternal and child health.
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Randomization Unit
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Before
Village
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After
Village and household
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Field
Additional Keyword(s)
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Before
social norms, maternal health, intrahousehold bargaining, peer effects
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After
health information, social norms, maternal health, intrahousehold bargaining, peer effects
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Field
Did you obtain IRB approval for this study?
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Before
No
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After
Yes
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