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Integration of an Essential Services Package (ESP) in Child and Reproductive Health and Family Planning with a Micro-credit Program for Poor Women: Experience from a Pilot Project in Rural Bangladesh
Abstract
In early 1992, a two-phased pilot project, initially integrating a micro-credit program for poor women with a family planning and expanded program of immunization (EPI) (in the first phase) and subsequently and incrementally with an essential services package (ESP) in reproductive and maternal and child health (in the second phase), was initiated in rural Bangladesh. Data on the project show that there has been a significant increase in contraceptive use and a decline in fertility since the initiation of the first phase of the project. There also has been an increase in the dissemination of information on, and utilization of, ESP medical technologies in the intervention community at large.
... The country settings included Nigeria (n = 2), Bangladesh (n = 3), Kenya, and Ghana. The two experimental studies used quasi-experimental pre-post designs (Amin, St. Pierre, Ahmed, & Haq, 2001;Mainthia et al., 2013). The four observational studies used cross-sectional designs (Hadi, 2001;Norwood, 2011;Nwokocha, 2012;Odutolu, Adedimeji, Odutolu, Baruwa, & Olatidoye, 2003); two of which were qualitative in nature (Nwokocha, 2012;Odutolu et al., 2003). ...
... Results from the reviewed experimental studies suggest that joint microfinance and access to health-related services can increase contraceptive use among participants (Amin et al., 2001;Mainthia et al., 2013). Mainthia et al. (2013) focused on the results of a quasi-experimental study of 60 women and found that women in the basic relief, microfinance, and business education and training intervention reported an increase in contraceptive use after two years in the programme (condom use 'every time' was 8% at baseline and 21% at follow-up). ...
... Mainthia et al. (2013) focused on the results of a quasi-experimental study of 60 women and found that women in the basic relief, microfinance, and business education and training intervention reported an increase in contraceptive use after two years in the programme (condom use 'every time' was 8% at baseline and 21% at follow-up). Amin et al. (2001) report that 53% of the 6250 women participating in a microfinance programme with access to health-related products reported an increase in contraceptive use at follow-up, compared to controls (38%) and baseline prevalence rate (28%) (Amin et al., 2001). Additionally, microfinance members were significantly more likely to use contraception than non-members when controlling for age, living children, education, and landowning (OR = 1.533, p < .01) ...
While growing evidence suggests that microfinance is an effective approach for improved women's health, a significant gap remains in our understanding. The objective of this review is to synthesise the findings from published literature focused on microfinance and health issues particularly affecting women, including HIV/AIDS, reproductive health, mental health, and violence. Forty-one articles that examine the impact of microfinance participation on women's health were identified through a systematic search of electronic databases, coded using a structured abstraction form, and synthesised. Review results indicate that the impact of microfinance on women's health is an area in great need of research and publication attention. Varied quality and reporting in the identified articles restricted the ability to draw concrete conclusions regarding the relationship between microfinance participation and women's health, but led to the identification of current gaps in existing published research. Future research should work to address the recommendations provided in order to offer additional evidence to better understand the use of microfinance programming as a structural intervention to improve women's health.
... In one study five local non-governmental organisations provided collateral free loans anchored on a health promotion programme (Amin & Li, 1997). These actors did not directly supply health services but promoted government programmes on safe motherhood (antenatal care and delivery), family planning (contraceptives, birth spacing) and child health (immunization and treatment seeking for diarrhoea and other childhood diseases) (Amin et al., 2001). The BRAC initiative integrated the prevention of acute respiratory infections with micro-credit to poor women considered as households that owned less than a half-acre of land and survived on selling manual labour (Hadi, 2002). ...
... We found low to very low quality evidence that innovative microfinance interventions for health service providers improved quality of care, whilst initiatives targeting recipients of primary healthcare showed a desirable general direction of impacts including: reduced infant mortality (Amin & Li, 1997;Amin et al., 2001); higher utilization of health services (Amin & Li, 1997;Amin et al., 2001;MkNelly & Dunford, 1998;Seiber & Robinson, 2007;Tseng & Khan, 2015); and strengthened business capacities of loan recipients compared to non-credit areas or members. Our findings are in consonance with two previous systematic reviews about initiatives to integrate microfinance and strategies to improve maternal and child health (Leatherman et al., 2012;Saha & Annear, 2014). ...
... We found low to very low quality evidence that innovative microfinance interventions for health service providers improved quality of care, whilst initiatives targeting recipients of primary healthcare showed a desirable general direction of impacts including: reduced infant mortality (Amin & Li, 1997;Amin et al., 2001); higher utilization of health services (Amin & Li, 1997;Amin et al., 2001;MkNelly & Dunford, 1998;Seiber & Robinson, 2007;Tseng & Khan, 2015); and strengthened business capacities of loan recipients compared to non-credit areas or members. Our findings are in consonance with two previous systematic reviews about initiatives to integrate microfinance and strategies to improve maternal and child health (Leatherman et al., 2012;Saha & Annear, 2014). ...
... The country settings included Nigeria (n = 2), Bangladesh (n = 3), Kenya, and Ghana. The two experimental studies used quasi-experimental pre-post designs (Amin, St. Pierre, Ahmed, & Haq, 2001;Mainthia et al., 2013). The four observational studies used cross-sectional designs (Hadi, 2001;Norwood, 2011;Nwokocha, 2012;Odutolu, Adedimeji, Odutolu, Baruwa, & Olatidoye, 2003); two of which were qualitative in nature (Nwokocha, 2012;Odutolu et al., 2003). ...
... Results from the reviewed experimental studies suggest that joint microfinance and access to health-related services can increase contraceptive use among participants (Amin et al., 2001;Mainthia et al., 2013). Mainthia et al. (2013) focused on the results of a quasi-experimental study of 60 women and found that women in the basic relief, microfinance, and business education and training intervention reported an increase in contraceptive use after two years in the programme (condom use 'every time' was 8% at baseline and 21% at follow-up). ...
... Mainthia et al. (2013) focused on the results of a quasi-experimental study of 60 women and found that women in the basic relief, microfinance, and business education and training intervention reported an increase in contraceptive use after two years in the programme (condom use 'every time' was 8% at baseline and 21% at follow-up). Amin et al. (2001) report that 53% of the 6250 women participating in a microfinance programme with access to health-related products reported an increase in contraceptive use at follow-up, compared to controls (38%) and baseline prevalence rate (28%) (Amin et al., 2001). Additionally, microfinance members were significantly more likely to use contraception than non-members when controlling for age, living children, education, and landowning (OR = 1.533, p < .01) ...
Background. Microfinance includes providing financial services, such as loans, to micro-entrepreneurs who otherwise lack access to banking services. Microfinance programs are recognized as a promising poverty alleviation mechanism for women, yet relatively little is known about the short and long term health impact of women's participation in such programs.
Methods. A systematic literature review process was used to identify and summarize peer-reviewed articles published in the PUBMED database between 1997-2012 that addressed microfinance and women's health. The resulting abstracts were reviewed and full-text for the 27 relevant articles were read and summarized.
Results. Microfinance programs are often offered in conjunction with health education and community action/mobilization. Existing published literature addressing the impact of microfinance programs on women's health focuses on a range of topics including gender equity, HIV, intimate partner violence, and malaria, yet fails to examine the impact of such programing on chronic diseases. Evidence suggests that microfinance combined with health education leads to better health knowledge, practice, and outcomes. A majority of the studies were located in African countries including South Africa, Ghana and Ethiopia, and South Asian countries including India and Bangladesh.
Conclusions. Existing research illustrates the positive impact of microfinance on women's health outcomes, but has largely focused on infectious diseases, been mainly conducted in Africa, and overall, failed to adequately examine long-term health behavior. Future longitudinal research is needed to explore the health impact of multi-pronged microfinance programs.
... It has also been recommended as an important strategy to reduce barriers to access to health care [1] and, more often than not, health gains are explicit objectives of these strategies [2]. Microcredit [3][4][5], user fee removal policies [6], voucher schemes [7] and cash transfer programs [8][9][10][11] that provide direct or indirect monetary incentives to households, with or without activity or behavioral conditionalities, have been used for decades in Latin American [9,[12][13][14] and sub-Saharan African countries [15][16][17][18][19], and in Southeast Asian settings [20][21][22][23][24]. ...
... We excluded 119 of these articles based on criteria defined a priori, either because they contained duplicate data to one of our included studies, did not include an eligible financial intervention, did not have a comparison group or relevant outcomes. In the end, 25 studies were included [7,8,10,15,16,[21][22][23]25,26,33,34,40,[42][43][44][45][46][47][48][49][50][51][52][53]. Figure 1 is a schematic representation of our search. ...
... Care-seeking Percentage of children that were taken to a health facility during the last episode of diarrhoea Mean difference in the change in the percentage of children taken to health facility during latest diarrhoea episode between intervention and control group [21][22][23]46]. 48% of the studies evaluated cash transfer programs: 41% evaluated conditional cash transfer programs and 7% evaluated unconditional cash transfer programs. ...
Financial incentives are widely used strategies to alleviate poverty, foster development, and improve health. Cash transfer programs, microcredit, user fee removal policies and voucher schemes that provide direct or indirect monetary incentives to households have been used for decades in Latin America, Sub-Saharan Africa, and more recently in Southeast Asia. Until now, no systematic review of the impact of financial incentives on coverage and uptake of health interventions targeting children under 5 years of age has been conducted. The objective of this review is to provide estimates on the effect of six types of financial incentive programs: (i) Unconditional cash transfers (CT), (ii) Conditional cash transfers (CCT), (iii) Microcredit (MC), (iv) Conditional Microcredit (CMC), (v) Voucher schemes (VS) and (vi) User fee removal (UFR) on the uptake and coverage of health interventions targeting children under the age of five years.
We conducted systematic searches of a series of databases until September 1st, 2012, to identify relevant studies reporting on the impact of financial incentives on coverage of health interventions and behaviors targeting children under 5 years of age. The quality of the studies was assessed using the CHERG criteria. Meta-analyses were undertaken to estimate the effect when multiple studies meeting our inclusion criteria were available.
Our searches resulted in 1671 titles identified 25 studies reporting on the impact of financial incentive programs on 5 groups of coverage indicators: breastfeeding practices (breastfeeding incidence, proportion of children receiving colostrum and early initiation of breastfeeding, exclusive breastfeeding for six months and duration of breastfeeding); vaccination (coverage of full immunization, partial immunization and specific antigens); health care use (seeking healthcare when child was ill, visits to health facilities for preventive reasons, visits to health facilities for any reason, visits for health check-up including growth control); management of diarrhoeal disease (ORS use during diarrhea episode, continued feeding during diarrhea, healthcare during diarrhea episode) and other preventive health interventions (iron supplementation, vitamin A, zinc supplementation, preventive deworming). The quality of evidence on the effect of financial incentives on breastfeeding practices was low but seems to indicate a potential positive impact on receiving colostrum, early initiation of breastfeeding, exclusive breastfeeding and mean duration of exclusive breastfeeding. There is no effect of financial incentives on immunization coverage although there was moderate quality evidence of conditional cash transfers leading to a small but non-significant increase in coverage of age-appropriate immunization. There was low quality evidence of impact of CCT on healthcare use by children under age 5 (Risk difference: 0.14 [95%CI: 0.03; 0.26]) as well as low quality evidence of an effect of user fee removal on use of curative health services (RD=0.62 [0.41; 0.82]).
Financial incentives may have potential to promote increased coverage of several important child health interventions, but the quality of evidence available is low. The more pronounced effects seem to be achieved by programs that directly removed user fees for access to health services. Some indication of effect were also observed for programs that conditioned financial incentives on participation in health education and attendance to health care visits. This finding suggest that the measured effect may be less a consequence of the financial incentive and more due to conditionalities addressing important informational barriers.
... Two studies [39,40] were identified that evaluated whether transferring cash or providing microfinance to postpartum women has an effect on family-planning outcomes. A cluster randomized controlled trial [39] of 5001 women used time series data to evaluate a program in Mexico that provided cash transfers to designated female household heads in poor communities conditional to their participation in health promotion activities and/or children's school attendance. ...
... A time series survey study [40] evaluated an intervention in Bangladesh that integrated the delivery of family-planning services, child immunization, and microcredit (small loans). In this study, an analysis of post-intervention data showed improvements in current contraceptive use in the experimental group (baseline 28.0%, experimental group 53.0%, control group 38.4%). ...
... Limitations of this study included the data collection in time series surveys and the merging of different survey data. The study by Amin et al. [40], which evaluated microfinance, included no power calculation or statistical analysis, and thus the effect of the intervention could not be fully assessed. ...
Background
WHO recommends birth spacing to improve the health of the mother and child. One strategy to facilitate birth spacing is to improve the use of family planning during the first year postpartum.
Objectives
To determine from the literature the effectiveness of postpartum family-planning programs and to identify research gaps.
Search strategy
PubMed and the Cochrane Central Register of Controlled Trials were systematically searched for articles published between database inception and March 2013. Abstracts of conference presentations, dissertations, and unpublished studies were also considered.
Selection criteria
Published studies with birth spacing or contraceptive use outcomes were included.
Data collection and analysis
Standard abstract forms and the US Preventive Services Task Force grading system were used to summarize and assess the quality of the evidence.
Main results
Thirty-four studies were included. Prenatal care, home visitation programs, and educational interventions were associated with improved family-planning outcomes, but should be further studied in low-resource settings. Mother–infant care integration, multidisciplinary interventions, and cash transfer/microfinance interventions need further investigation.
Conclusions
Programmatic interventions may improve birth spacing and contraceptive uptake. Larger well-designed studies in international settings are needed to determine the most effective ways to deliver family-planning interventions.
Synopsis
Prenatal care, home visitation programs, and educational interventions seem to improve postpartum family-planning outcomes.
... More specifically, we pay attention to gender relations, that is, to the roles established within the framework of family economy, and, specifically, attend to the role of women linked to the field of informal economies. The role of women in care activities and their relevance is a key element in the social reproduction of the family as a socio-cultural institution [8][9][10][11]. At this point, we should mention that we understand socio-cultural reproduction as the social process through which culture is reproduced across generations, especially through the socializing influence of major institutions [12]. We think that this review will allow us to offer a perspective on present and future lines of research where women appear as key figures. ...
... That is, if we attend to different organizations and disciplines, we will find different "degrees" in relation to the idea of poverty. Thus, the concepts of absolute poverty and relative poverty attend to the economic dimensions; the definition offered by the United Nations interprets access to the socio-economic dimension to assess poverty; the World Bank maintains the previous criteria and includes Human Rights; from Economics, the access to resources and opportunities to create a standard of living is addressed; Sociology studies include social variables such as dignity and quality of life [23]; from Psychology, reference is made to the stigmatization that poverty implies [24]; from the Political Sciences, the concepts of freedom, representation, and violation of Human Rights are addressed; and finally, we could refer to the criteria of the World Health Organization (WHO), which takes into account access to health facilities, subsistence, and adequate nutrition [9,25,26]. ...
The concept of family economy in the context of extreme poverty is of interest when it comes to analyzing the strategies displayed to prevent or reduce the effects of this situation of exclusion. Gender roles in the nucleus of the family institution will indicate the distribution of these tasks, so that we can understand, in the case of the role of women, the specific weight of their actions in this scenario. For this work, an investigation of our object of study was carried out for the period 1968–2019. A bibliometric analysis of 2182 articles was carried out in which the final versions of articles, books, and book chapters whose subject matter was related to the categories of family economy and poverty were included. The most productive journal was the Journal of Development Economics, while World Economies was the most cited. The authors with the most articles were Ravaillon, Sadoulet, and Lanjouw. The most productive institution was the World Bank. The country with the most publications and citations was the United States. Future research should focus on analyzing the role of women within the family economy in the context of poverty. Thus, a line of research is proposed that also includes the proposals from the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals, which means an urgent call for action by all countries.
... Recent and increasing work has focused on promoting women's social status and autonomy in the household as a means of improving various reproductive health indicators among women [28][29][30]. Specifically, recent studies have supported a link between factors indicative of women's social status and autonomy in the household (e.g. decisionmaking power in the household) and greater utilization of family planning methods [31][32][33], Among these indicators of women's social status and autonomy has included women's access to spending money. ...
... Focusing on access to spending money among women and relation to improvements in their reproductive health is especially timely given the number of economic interventions (e.g. microfinance, microenterprise, cash transfers) [28][29][30][31][32][33][34][35][36][37][38] in India and elsewhere that have focused on reproductive health outcomes and targeted poor populations of women, particularly rural women who have experienced significant economic deprivation and disenfranchisement. Interventions to support women's access to money as an independent means to improve women's reproductive control may also be especially critical in such rural contexts where social norms to support women's power in family planning decision-making have not been readily adopted. ...
Objectives The social positioning (i.e. social status and autonomy) of women in the household facilitates women's access to and decision-making power related to family planning (FP). Women's access to spending money, which may be an indicator of greater social positioning in the household, may also be greater among women who engage in income generating activities for their families, regardless of women's status in the household. However, in both scenarios, access to money may independently afford greater opportunity to obtain family planning services among women. This study seeks to assess whether access to money is associated with FP outcomes independently of women's social positioning in their households. Methods Using survey data from married couples in rural Maharashtra, India (n = 855), crude and adjusted regression was used to assess women's access to their own spending money in relation to past 3 month use of condoms and other forms of contraceptives (pills, injectables, intrauterine device). Results Access to money (59 %) was associated with condom and other contraceptive use (AORs ranged 1.5-1.8). These findings remained significant after adjusting for women's FP decision-making power in the household and mobility to seek FP services. Conclusion While preliminary, findings suggest that access to money may increase women's ability to obtain FP methods, even in contexts where social norms to support women's power in FP decision-making may not be readily adopted.
... We focused on how MFI hospital utilization was characterized by the socioeconomic positions of female patients. Guided by theoretical and empirical studies in South Asian countries, we developed our conceptual framework and questionnaire accordingly [3,6,7,21,40,41]. The survey collected independent variables of age, level of education, marital status, family size, microcredit membership and duration, monthly household income, self-rated health, perceived needs for preventive care (e.g. ...
... Length of participation in credit programs exhibited a significant impact on a woman's choice of provider. This finding was consistent with existing literature in which microcredit membership was associated with an array of positive outcomes, i.e. service utilization [6,21], health behaviours [52,53] and maternal knowledge [54]. The dose-effect relationship was indicated in previous explorations between duration of membership and outcomes like poverty reduction or health knowledge [55][56][57][58], as a result of borrowers' enhanced capabilities over time [59]. ...
IntroductionHealth programs implemented by microfinance institutions (MFIs) aim to benefit the poor, but whether these services reach the poorest remains uncertain. This study intended to investigate the socioeconomic distribution of patients in hospitals operated by microfinance institutions (i.e. MFI hospitals) in Bangladesh and compare the differences with public hospitals to determine if the programs were consistent with their pro-poor mandate.Methods
In this cross-sectional study, we used the convenience sampling method to conduct an interviewer-assisted questionnaire survey among 347 female outpatients, with 170 in public hospitals and 177 in MFI hospitals. Independent variables were patient characteristics categorized into predisposing factors (age, education, marital status, family size), enabling factors (microcredit membership, household income) and need factors (self-rated health, perceived needs for care). We employed Generalized Estimating Equations (GEE) to evaluate how these factors contributed to MFI hospital use.ResultsUse of MFI hospitals was associated with microcredit membership over 5 years (OR=2.9, p
... Nanda (1999) illustrated the impact of some microcredit programmes on the utilisation of formal health care. Amin et al. (2001) examined the impact of a pilot health programme on the utilisation of essential services package (ESP), an intervention of the health authorities in Bangladesh (MoHFW) that targeted delivery of primary care to the rural residents (upazila and below) to be offered by public facilities, which launched in 1998. ...
... of micro health insurance (MHI) on health care seeking behaviour along with indicators like health awareness and health status of the microcredit members using a sample of 329 households drawn from 4 villages of a sub-district of Manikganj. Nanda (1999) illustrated the impact of some microcredit programmes on the utilisation of formal health care. Amin et al. (2001) examined the impact of a pilot health programme on the utilisation of essential services package (ESP), an intervention of the health authorities in Bangladesh (MoHFW) that targeted delivery of primary care to the rural residents (upazila and below) to be offered by public facilities, which launched in 1998. 3 Ahmed et al. (2005) compar ...
This paper provides an analysis of the utilisation of formal health care and out-ofpocket
(OOP) payments in rural areas of Bangladesh. The broader focus of the
investigation is to gauge how far Bangladesh has to traverse to achieve universal
health coverage (UHC). We used the data from the baseline survey (conducted in
diversifi ed geographical locations on about 4,000 households) of a longitudinal
research project (entitled Microinsurance, Poverty and Vulnerability) of the Institute
of Microfi nance (InM). The study fi nds that over 12-month period, only 40 per
cent of the 6,352 sick individuals utilised formal health care. The poor and the
children are the most deprived section in the utilisation. Out-of-pocket expenses
per affected household during 12 months preceding the survey was BDT 4,686,
which accounted for about 6 per cent of the total household expenditure. Drug, the
single largest component of the OOP category, accounts for about 60 per cent of
the direct OOP expenditure. The incidence of catastrophic expenditure was 15 per
cent at the 10-per cent threshold level. In about 33 and 41 per cent of the cases,
households needed to borrow or deplete assets for coping with inpatient care and
catastrophic illnesses, respectively. Poor effective access to formal healthcare and
high OOP expenditure indicate that Bangladesh has major challenges to overcome
in achieving the universal health coverage. Membership in Grameen Kalyan micro
health insurance scheme, essentially a discounted basic care package, has
a signifi cant association with the likelihood of using formal health care, though
access to microcredit appear not to relieve households of the need to search for
additional funds to cope with catastrophic events. An obvious suggestion is to
introduce a risk-sharing mechanism (e.g., micro health insurance) to pool funds
for the provision of health care in rural areas. Awareness building on the value of
professional medical advice and measures targeted at effective regulation of the
prices of essential drugs and restricting the sales of over-the-counter drugs are
also put forward as elements of a sound public health policy framework.
Key words: Health care seeking behaviour, out-of-pocket payments, catastrophic
illness, Bangladesh.
JEL Classifi cation: G22, J44, I12, H51, H52, H53, and H75.
... Findings reveal no significant improvement in quality of life related to medical consumption, nutritional intake, and social participation. The implication is that at present there is little awareness, financial ease, and personal willingness of women users to invest in significant areas related to nutrition and health for self and household, contradicting the sugges-tion of some analysts (Amin, St Pierre, Ahmed, & Haq, 2001). Findings highlight that awareness for health and nutritional needs of women client must be raised to improve health quality of life, reproductive health, girl-child health, and old-age health. ...
... The additional income generated through the activities supported by micro credit facilities helps them to be self -reliable and upkeep their health without being much dependent on anyone. Microcredit would make it possible for women to take more medical consultation and better treatment (Amin et al., 2001). ...
The chapter presents the vital role of micro credit in the empowerment of rural women. Indian women who live by the countryside generally isolate themselves within the confines of their homes and are actively involved in agricultural and related activities. Since women comprise 48.5% of the total Indian population, it becomes imperative to address the economic needs of this segment and hence this chapter is proposed. The chapter highlights the various schemes and non-governmental initiatives that help provide micro credit to rural, marginalized Indian women. These initiatives directly and indirectly make Indian rural women empowered financially, psychologically, and physically. The Sustainable Development Goals (SDGs) have been laid out by the United Nations because of the decades of hard work by various countries. It can be inferred by the chapter that the SDGs related to health, education, and women empowerment in rural areas can be very successfully managed by micro credit channels.
... In most of the research studies, SHGs have been termed and accepted as practically useful set-ups which are instrumental in bringing about social, political and economic empowerment of women (Amin et al., 2001;Robinson and Net Library, 2001;Robinson, 2002;Antia and Kadekodi, 2002;Jahan et al., 2004;Rajendra, 2015;Rahman and Sultana, 2012;Ramanathan, 2004). These studies have been conducted at different intervals of time across different states to check and test the sustainability factor of these like Mewat (Alam and Nizamuddin, 2012), Uttar Pradesh, Andhra Pradesh and Maharashtra (Swain and Wallentin, 2007), West Bengal (Roy, 2011), Kalahandi district of Orissa (Nayak, 2007), Kancheepuram District in Tamil Nadu (Chitra and Choudary, 2013), Haryana (Tushir et al., 2007), Orissa (Vinayamoorthy and Pithoda, 2007) and Tamil Nadu (Kumararaja, 2009). ...
In India, the Self-Help Groups (SHGs) are playing a commendable role in poverty alleviation by reaching out to the poor rural women which forms the major percentage of their membership. These groups are determined to eradicate poverty from the country as these are truly active at the grass root level. An effort has been made to survey 388 respondents from four blocks of Ghaziabad district to find the impact of SHGs on the rural women at three unique levels namely social, economical and political. The study at hand reveals that women have become more authoritative socially and cost-effectively yet there is still the scope of upgrading with respect to Political empowerment. The members of SHGs in have become more confident and independent decision makers to a considerable extent.
... In most of the research studies, SHGs have been termed and accepted as practically useful set-ups which are instrumental in bringing about social, political and economic empowerment of women (Amin et al., 2001;Robinson and Net Library, 2001;Robinson, 2002;Antia and Kadekodi, 2002;Jahan et al., 2004;Rajendra, 2015;Rahman and Sultana, 2012;Ramanathan, 2004). These studies have been conducted at different intervals of time across different states to check and test the sustainability factor of these like Mewat (Alam and Nizamuddin, 2012), Uttar Pradesh, Andhra Pradesh and Maharashtra (Swain and Wallentin, 2007), West Bengal (Roy, 2011), Kalahandi district of Orissa (Nayak, 2007), Kancheepuram District in Tamil Nadu (Chitra and Choudary, 2013), Haryana (Tushir et al., 2007), Orissa (Vinayamoorthy and Pithoda, 2007) and Tamil Nadu (Kumararaja, 2009). ...
... It is rightly observed by Pattanaik (2003), Amin et al. (2001), Robinson and Net Library (2001) and Robinson (2002), that the social, political and economic development of the rural women has been caused through microfinance via SHGs. It has further helped in enhancing and establishing capacity building and self-efficiency among women (Manimekalai, 2004). ...
Purpose
This paper aims to explore the factors for self-help groups (SHGs) women empowerment in the state of Uttar Pradesh using the primary data.
Design/methodology/approach
The primary data have been collected by a household survey in the four districts of Uttar Pradesh. Factor analysis is used to estimate the odd of improving women empowerment after participating in SHG.
Findings
Factor analysis extracted four factors which were economic development, improvement in family matters, decision to use public amenities and political empowerment. Also, analysis of variance and t -test was used employing SPSS. The results, therefore, show that education has a significant impact on all the aspects of SHGs people.
Practical implications
The findings of the study can help policymakers to adopt appropriate policies that integrate empowerment in development projects with women.
Social implications
The results of this research could encourage more women to participate in SHG activities and development projects.
Originality/value
This research provides the most updated data from a primary survey in the state of Uttar Pradesh.
... Some studies have found positive results, including female empowerment and decreased violence against women (Amin et al., 1998;Hashemi et al., 1996). Other studies have cited unintended side effects of micro-credit, including increased violence against women, negative peer-pressure linked to loan repayment, and emotional stress of females due to family-related conflicts (Ahmed et al., 2001, Montgomery, 1996Rahman, 1998). Two other problems women faced were in the domain of family and health. ...
SHGs were formed with the aim to empower women at the grass root level in a systematic manner. SHGs provide economic empowerment through skill development in order to assist women acquire power and develop their personality to face the challenges in living. Empowerment here is achieved by purposive conscientization, by giving external stimulus for women’s development. Empowerment of women – the basic concept behind SHGs, means more than achieving equality; social justice too is implied.
Given the above background, the authors deemed it worthwhile to look at the vying evidence and draw their own conclusions regarding whether indeed the SHG movement has supported social development or withered. With this in mind the authors have examined how the women are motivated to join the SHGs and to take up employment for economic development, which presumably later would contribute to holistic empowerment. It was also proposed to examine the various hurdles coastal women face, and whether indeed, involvement in SHGs actually lead to empowerment. The study was conducted among the women in the coastal areas.
The introduction of SHG by the Government supported by other allied agencies, leased a new of life to the fisherwomen living in the coastal area, as it provided a window of opportunity for these women, and through them, their families, to achieve upward social mobility. Upward social mobility or empowerment of women usually took place in three stages, viz. motivation by experts, a kind of anticipatory mental social mobility and actual actions. The formation of women’s groups, regular savings and income, a new perspective and knowledge, conscious group mobilization, frequent dialogue leading to cooperative decision making, together contributed towards creating an alternative to women’s traditional role. Thus, it turn enhanced the women’s ability to articulate and ensure them a relatively higher status in family and in the village. Hence, one gathers that women were capable of gathering themselves to seize the opportunity for their individual development as well as that of their family members.
This increase in household income and exposure to novel experiences with enterprises and allied financial institutions, however, did not translate into women acquiring new status or power within the family. Further, it was found that women were harassed by their spouses, plagued by technical problems concerning marketing and more importantly, the increasing exposed to health hazards resulting in elevated morbidity rates. While some label micro-credit as revolutionary movement and a new paradigm for development, there is still much to ponder on the real impacts of micro-credit.
... For example, Amin et al describe a collaboration between a local NGO, funded by USAID, and local government to provide expanded immunisation programme and microcredit assistance, along with FP services, in rural Bangladesh. 31 Microcredit loans are a source of financial empowerment for poor women, and are often the first step in breaking down informational and cultural barriers to health services, particularly FP. [32][33][34][35] If the foreign NGO described by Amin et al declined to certify PLGHA, or misinterpreted the restrictions, resulting impacts could include fewer referrals for rural women to antenatal and delivery care, disruption of childhood immunisations, and decreased access to microcredit assistance for women. ...
During his first week in office, US President Donald J Trump issued a presidential memorandum to reinstate and broaden the reach of the Mexico City policy. The Mexico City policy (which was in place from 1985–1993, 1999–2000 and 2001–2009) barred foreign non-governmental organisations (NGOs) that received US government family planning (FP) assistance from using US funds or their own funds for performing, providing counselling, referring or advocating for safe abortions as a method of FP. The renamed policy, Protecting Life in Global Health Assistance (PLGHA), expands the Mexico City policy by applying it to most US global health assistance. Thus, foreign NGOs receiving US global health assistance of nearly any type must agree to the policy, regardless of whether they work in reproductive health. This article summarises academic and grey literature on the impact of previous iterations of the Mexico City policy, and initial research on impacts of the expanded policy. It builds on this analysis to propose a hypothesis regarding the potential impact of PLGHA on health systems. Because PLGHA applies to much more funding than it did in its previous iterations, and because health services have generally become more integrated in the past decade, we hypothesise that the health systems impacts of PLGHA could be significant. We present this hypothesis as a tool that may be useful to others’ and to our own research on the impact of PLGHA and similar exogenous overseas development assistance policy changes.
... Microenterprise credit programs have received innumerable support in the past decades and a Nobel prize simply bolsters the effectiveness of this solution in addressing female empowerment. However, these mechanisms to support women's income generating opportunities and economic empowerment have been contested [49][50][51][52][53][54][55][56] and Omorodion [53] points to the inconclusive nature of the micro-credit programs in improving the economic situation of women. A reading on the topic of daily mobilities highlights that economic empowerment and mobilities remain interlocked. ...
The Millennium Development Goals (MDGs) specifies gender equality and sustainable development as their two central priorities. An area of critical importance for sustainable and gender-fair development is mobility and transport, which has so far been neglected and downplayed in research and policy making both at the national and global levels. Rooted in the history of the topic and the emerging ideas on smart, green and integrated transport, this paper presents a literature review of on gender and transport in the low- and middle-income countries. The paper presents a host of cross-cutting topics with a concentrated focus on spatial and transport planning. The paper further identifies existing research gaps and comments on the new conceptualizations on smart cities and smart mobilities in the Global South. Due attention is paid to intersections and synergies that can be created between different development sectors, emerging transport modes, data and modeling exercises, gender equality and sustainability.
... 1,2 Although these improvements are promising, gaps remain in neonatal, child, and maternal health indicators. 3,4 For example, among children under the age of 5 years, 36% are stunted (low height-for-age) and 14% are wasted (low weight-for-height). 1 Malnutrition begins at birth for many infants, as nutritional deficiencies among pregnant women have substantially contributed to low birth weight rates in the country. 5 Only 55% of infants younger than 6 months of age are exclusively breastfed, and complementary foods are typically not introduced according to recommended guidelines. ...
Community health workers, also known as fieldworkers (FWs), are frontline health-care providers in Bangladesh, where unmet need in family planning outcomes related to maternal and child health are high. A digital health intervention provided netbook computers to Bangladeshi FWs with eLearning courses and an eToolkit, which included material on family planning, maternal, newborn, and child health topics to enhance FWs’ knowledge and skills. To understand how the intervention affected FW’s knowledge and counseling behavior, this pre-poststudy measured FWs’ knowledge related to family planning, maternal, newborn, child health, and counseling on family topics before and after the pilot. Bivariate analyses were used to determine changes in FW knowledge, and multivariate analyses were conducted to determine changes in behavior, comparing knowledge and behaviors prepilot to postpilot. Comparing mean knowledge scores after and before the pilot, the difference in mean scores was significant (p < .05) related to knowledge of benefits of birth spacing (1.26) and benefits of a small family (1.3) and related to maternal health, anemia prevention (0.95), and recommended number of antenatal care visits (0.13). Regarding newborn and child health, the difference in mean scores was significantly (p < .05) related to knowledge of proper attachment for breastfeeding (3.56) and signs of adequate breast milk supply (1.08). Postintervention, FWs were significantly more likely to counsel couples on all available contraceptive options (adjusted odds ratio: 4.64; 95% CI [3.16, 6.83]) and birth spacing benefits (adjusted odds ratio: 4.54; 95% CI [3.17, 6.50]). Digital health training approaches can improve FWs’ knowledge and counseling skills within an international context, specifically in low-resource settings.
... Various micro-level studies from low-and middle-income countries have shown the potential of CHW interventions for various health outcomes (for reviews see [8,[26][27][28][29]). While most evaluations are focused on large-scale national programs, there is little evidence on CHW programs implemented by MFIs outside the public health sector [11,13,16,30]. The KDCI health workers can be seen as a form of community health promoters whose main focus is the prevention of diseases by promoting and encouraging good health practices and disseminating information in their immediate environment. ...
Background:
Community Health Workers (CHWs) are considered to be a cost-effective and inclusive solution to address the persistent health workforce shortage in many low and middle-income countries. In recent years, microfinance institutions (MFIs) got increasingly engaged in providing health services delivered by CHWs. Despite their growing importance, little is known about the impacts and implementation barriers of these mostly small-scale initiatives. This paper evaluates an MFI-led CHW program in the Philippines and studies the role of microfinance group networks in influencing program outreach and impact. The intervention aims at disseminating information in poor communities, improving health monitoring through increased check-ups and raising social support.
Methods:
Clustered randomized controlled trial in 70 communities in the greater area of Metro Manila, the Philippines. The main data was collected in a baseline and follow-up survey and is complemented with extensive sociometric network and geographical data. The main outcome variable is a composite health index based on 10 indicators. The role of the health worker's embeddedness and connectedness in the community for program success is tested using tools of social network analysis.
Results:
The intervention led to a 3.8% (95% confidence interval (CI) = 1.3, 6.4) improvement in the composite health outcome. Effects across indicators are mixed and mainly driven by changes in immediate health monitoring behavior: The probability for routine examinations increased in the treatment group by 10.6% (95% CI = 3.2, 18.1), for regular blood pressure checks by 9.6% (95% CI = 3.3, 15.9), and for having access to a health care provider by 7.2% (95% CI = 0.93, 13.5). No statistical effects on general knowledge and social support are observable. Social networks are a key driver of program outreach and impact. Close friends and acquaintances of health workers used and benefited substantially more from the program than more distant ties.
Conclusions:
Despite the promising immediate behavioral impacts, it remains questionable to what extent such small-scale MFI initiatives can bring transformative and sustainable changes without external support. Microfinance group networks played an important role for the success of the health intervention and further research is needed to better understand how these affect the health care utilization decisions of the clients.
... Elsewhere, a clustered and randomized trial among the indigenous communities in Jharkhand and Odisha States of India found that the newborn babies born in the communities with an SHG had a significantly improved likelihood of surviving the first six weeks of life, compared to the babies born to the corresponding households in the non-SHG communities (Montalvao J. et al. 2011) (Tripathy P. et al. 2010). A study of the microcredit forum of BRAC, a non-government development organization in Bangladesh, found a significant positive effect of membership in the forum on the maternal knowledge of prenatal care, increased use of contraceptives, and a decline in fertility and (Amin R. et al. 2001). However, despite this evidence, using these mechanisms to address the health needs of the poor does not appear to be a high priority for the health planners in India, ibid. ...
In independent India, development policies pursued by the successive governments have been leading to the widespread displacement of population. It is estimated that nearly five lakh people are displaced every year as a direct consequence of the administrative land acquisitions. Displacement of people may occur due to many reasons like earthquakes, floods, infrastructure development, dam construction, etc. Majority of the displaced people are poor and they also suffer the most from displacement. It appears that the development has made the rich richer, while the cost of the development is borne by the displaced poor. It creates some specific problems like marginalization, increased morbidity and mortality, food insecurity, family loss, etc. The study uses gender perspective and attempts to examine the gender inequality as an offshoot of resettlement. It has been found that due to the absence of uniform rehabilitation and resettlement policy in India, most of the displaced women face difficulties with regard to their compensation and rehabilitation, employment, etc. Displaced women do not find mention in the rehabilitation policy as they are considered to be the dependent family members. In rural India, most of the women, in order to help their families economically, are directly dependent upon the natural resources. In the wake of displacement they do not get any kind of benefits from the Government. They always face gender discrimination by the Government with regards to their compensation and rehabilitation policy. Keywords: Displacement, Rehabilitation, Resettlement, Compensation, Gender Inequality, and Displaced women.
... The development of the third world countries is partly a result of health improvements. Microcredit would make it possible to women to have better treatments and more medical consultations (Amin et al., 2001). This is more important in the Egyptian context since the Egyptian social security and insurance systems are not very efficient. ...
... 22 Microfinance encompasses a broad array of financial products, including payments, credit, and insurance, tailored to meet the particular needs of low-income individuals. 23 Microfinance initiatives have been shown to improve health outcomes, 24,25 with the impact enhanced when coupled with health initiatives, 26 in the areas of infectious diseases, 27 women's health, 28,29 child health, 30 and health insurance. 31 However, the impact of microfinance on CVD risk reduction has not been well studied. ...
Background:
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of morbidity and mortality among individuals with DM. There is a critical period now during which reducing CVD risk among individuals with diabetes and pre-diabetes may have a major impact. Cost-effective, culturally appropriate, and context-specific approaches are required. Two promising strategies to improve health outcomes are group medical visits and microfinance.
Methods/design:
This study tests whether group medical visits integrated into microfinance groups are effective and cost-effective in reducing CVD risk among individuals with diabetes or at increased risk for diabetes in western Kenya. An initial phase of qualitative inquiry will assess contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction. Subsequently, we will conduct a four-arm cluster randomized trial comparing: (1) usual clinical care, (2) usual clinical care plus microfinance groups only, (3) group medical visits only, and (4) group medical visits integrated into microfinance groups. The primary outcome measure will be 1-year change in systolic blood pressure, and a key secondary outcome measure is 1-year change in overall CVD risk as measured by the QRISK2 score. We will conduct mediation analysis to evaluate the influence of changes in social network characteristics on intervention outcomes, as well as moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of the interventions. Cost-effectiveness analysis will be conducted in terms of cost per unit change in systolic blood pressure, percent change in CVD risk score, and per disability-adjusted life year saved.
Discussion:
This study will provide evidence regarding effectiveness and cost-effectiveness of interventions to reduce CVD risk. We aim to produce generalizable methods and results that can provide a model for adoption in low-resource settings worldwide.
... In short, microfinance institutions have been expected to reduce poverty, which is considered as the most important development objective (World Bank 2000). The success of microfinance institutions in achieving their development objectives has been revealed by many studies on that subject since the mid 1990s (Remenyi 1991;Hashemi, Schuler et al. 1996;Khandker 1996;Pitt and Khandker 1996;Hulme and Mosley 1996a;Hulme and Mosley 1996b;Khandker, Samad et al. 1998;Rutherford 1998;Remenyi and Quinones Jr. 2000;Amin, Pierre et al. 2001;Robinson 2001;Robinson 2002;Remenyi 2004). ...
... 15 A second study in rural Bangladesh (2001) showed that introducing integrated family planning and child immunization services increased contraceptive prevalence from 28% to 53%. 16 However, a more recent (2009)(2010) cluster-randomized controlled trial in Ghana and Zambia that used screening and referral to family planning services demonstrated no increase in contraceptive method use among postpartum women attending infant immunization. 17 The remaining evidence to support the strategy is largely derived from observational studies or programmatic experiences. ...
Objective: The primary objective of this study was to test the effectiveness of integrating family planning service components into infant immunization services to increase modern contraceptive method use among postpartum women.
Methods: The study was a separate sample, parallel, cluster-randomized controlled trial. Fourteen randomly selected primary health facilities were equally allocated to intervention (integrated family planning and immunization services at the same time and location) and control groups (standard immunization services only). At baseline (May–June 2010), we interviewed postpartum women attending immunization services for their infant aged 6 to 12 months using a structured questionnaire. A separate sample of postpartum women was interviewed 16 months later after implementation of the experimental health service intervention. We used linear mixed regression models to test the study hypothesis that postpartum women attending immunization services for their infants aged 6–12 months in the intervention facilities will be more likely to use a modern contraceptive method than postpartum women attending immunization services for their infants aged 6–12 months in control group facilities.
Results: We interviewed and analyzed data for 825 women from the intervention group and 829 women from the control group. Results showed the intervention had a statistically significant, positive effect on modern contraceptive method use among intervention group participants compared with control group participants (regression coefficient, 0.15; 90% confidence interval [CI], 0.04 to 0.26). Although we conducted a 1-sided significance test, this effect was also significant at the 2-sided test with alpha = .05. Among those women who did not initiate a contraceptive method, awaiting the return of menses was the most common reason cited for non-use of a method. Women in both study groups overwhelmingly supported the concept of integrating family planning services components into infant immunization services (97.9% in each group), and service data collected during the intervention period did not indicate that the intervention had any negative effect on infant immunization service uptake.
Conclusion: Integrating family planning service components into infant immunization services can be an acceptable and effective strategy to increase contraceptive use among postpartum women. Additional research is needed to examine the extent to which this integration strategy can be replicated in other health care settings. Future research should also explore persistent misconceptions regarding the relationship between return of menses and return to fertility during the postpartum period.
... Not only female borrowers do have better repayment record but also return to their investment seem to better reach all the household members, especially in terms of improving children health and their school enrollment [8]. Improvement of women's self-esteem as well as her family status is also found to have been taken forward through microcredit [9] [10]. Malhotra and Schuler (2005) conducted a work considering the most commonly used indicators for measuring women's empowerment. ...
This study tries to reveal the role of microcredit in enhancing women empowerment in south-west region of Bangladesh, especially in Batiaghata Upazila of Khulna District. The sample size is 80 which has been selected randomly, and, is comprising of equal number of microcredit taker and non-microcredit taker women of Batiaghata Upazila which has been selected randomly, engaged in poultry farming. Cumulative Empowerment Index (CEI) is constructed and multiple linear regression model is used to find out women empowerment status. By using CEI, the study has found that the microcredit taker women are economically more empowered than the non-microcredit taker women. By using multiple linear regression model, the study also finds that, contribution to household income, monthly investment, and new addition to asset ownership of the respondents have statistically significant effect on women empowerment. But status regarding microcredit taking gives statistically insignificant result. Above all, based on the empirical result, it can be concluded that status regarding microcredit has a positive effect on economic empowerment of women in the study area.
... 15 A second study in rural Bangladesh (2001) showed that introducing integrated family planning and child immunization services increased contraceptive prevalence from 28% to 53%. 16 However, a more recent (2009)(2010) cluster-randomized controlled trial in Ghana and Zambia that used screening and referral to family planning services demonstrated no increase in contraceptive method use among postpartum women attending infant immunization. 17 The remaining evidence to support the strategy is largely derived from observational studies or programmatic experiences. ...
... 9 A study of the microcredit forum of BRAC, a non-government development organization in Bangladesh, found a significant positive effect of membership in the forum on maternal knowledge of prenatal care, increase use of contraceptive use, and a decline in fertility. 10,11 However, despite this evidence, using these mechanisms to address the health needs of the poor does not appear to be a high priority for health planners in India. And while India has large programs e both government and non-government organized e to promote microfinance schemes to poor women, there is limited evidence on the role of health programs attached to microfinance-based SHGs in improving health outcomes of the poor. ...
Women's participation in microfinance-based self-help groups (SHGs) and the resultant social capital may provide a basis to address the gap in health attainment for poor women and their children. We investigated the effect of combining a health program designed to improve health behaviours and outcomes with a microfinance-based SHG program.
A mixed method study was conducted among 34 villages selected from three blocks or district subdivisions of India; one in Gujarat, two in Karnataka.
A set of 17 villages representing new health program areas were pair-matched with 17 comparison villages. Two rounds of surveys were conducted with a total of 472 respondents, followed by 17 key informant interviews and 17 focus group discussions.
Compared to a matched comparison group, women in SHGs that received the health program had higher odds of delivering their babies in an institution (OR: 5.08, 95% CI 1.21-21.35), feeding colostrum to their newborn (OR: 2.83, 95% CI 1.02-5.57), and having a toilet at home (OR: 1.53, 95% CI 0.76-3.09). However, while the change was in the expected direction, there was no statistically significant reduction in diarrhoea among children in the intervention community (OR: 0.86, 95% CI 0.42-1.76), and the hypothesis that the health program would result in decreased out-pocket expenditures on treatment was not supported.
Our study found evidence that health programs implemented with microfinance-based SHGs is associated with improved health behaviours. With broad population coverage of SHGs and the social capital produced by their activities, microfinance-based SHGs may provide an avenue for addressing the health needs of poor women.
Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
... Consequently, multiple microenterprise credit programmes sprung up in recent years, which have endeavoured to develop "informal" financial mechanisms to reach women in a friendlier environment. However, as Omorodion Access to market, training skills and education need to be made integral part of micro-credit schemes Source: Ari Yuniasti [ari_yuniasti@yahoo.com] (2007) contends that though much research has been done on the effectiveness of micro-credit programs in improving the economic situation of women Schuler et al., 1997;Mayoux, 1999;Ahmed et al., 2001;Amin et al., 2001;Perry, 2002;Pitt et al., 2003;Izugbara, 2004), the findings have been inconclusive. For example, Pitt et al. (2003) found that women's participation in microcredit programs did increase their empowerment but Perry's (2002) analysis shows that although capital was useful to the participants, they were unable to make repayments as they were forced and cajoled by their spouses to hand over the money meant for repayment to them to reinvest in their own economic activities, thus questioning the assumption that empowerment is simply a matter of handing over credit. ...
... Obviously, the number of children in the household determines the potential supply of child labour, and hence fertility behaviour is a determinant of the supply of child labour. Amin et al., 2001 examine the impacts of microcredit with and without health care facilities. They observed that women who have access to health care with microinsurance significantly increase contraceptive use and therefore, there is a decline in fertility. ...
This research aims to discover whether access to microinsurance might make any difference for the microcredit receivers in reducing child labour by decomposing households into three broad groups: microcredit participants with microinsurance, microcredit participants without microinsurance and non-participants of microcredit and microinsurance. In extremely poor households, quasi health and/or microlife insurance in combination with microcredit have a significant effect of reducing child labour. In moderately poor households, microinsurance does not make any difference in determining child labour. Microfinance has no role in determining child labour in households above the poverty level.
... Members in the intervention area had higher use of static clinic services for the purpose of vaccination, minor illnesses, family planning and nutritional supplements, compared to non-members. 34 In September 2007, the United Nations Children's Fund (UNICEF) and Hindustan Lever Limited collaborated in a pilot study among 200 schools in Krishnigiri district of Tamil Nadu, India, designed to provide (through a local credit group) safe drinking water to children in school, while increasing awareness and adoption of effective point-of-use water treatment at home. The intervention consisted of placing a water purification system in classrooms; providing basic instruction to students, parents and teachers on waterborne diseases; and providing generic information on effective point-of-use water treatment (boiling, chlorination, filtration, solar disinfection and safe storage). ...
It is a challenge for the poor to overcome the barriers to accessing health services. Membership-based microfinance with associated health programmes can improve health outcomes for the poor. This study reviewed the evidence published between 1993 and 2013 on the role of membership-based microfinance with associated health programmes in improving health outcomes for the poor in South Asia. A total of 661 papers were identified and 26 selected for inclusion, based on the relevance and rigour of the research methods. Of these 26, five were evidence reviews. Of the remaining 21 papers, 12 were from India, seven from Bangladesh, and one each from Sri Lanka and Indonesia. Three papers addressed more than one theme. Five key themes emerged from the review: (i) the impact of microfinance programmes on the social and economic situation of the poor; (ii) the impact of microfinance programmes on community health; (iii) the impact of integrated microfinance health programmes on raising client awareness; (iv) the impact of integrated microfinance health programmes on financing health care; and (v) the impact of integrated microfinance health programmes on affordable health-care products and services. The review provides new evidence on the pathways through which microfinance helps to improve population health and value for money for such programmes. Among countries with large populations in the informal sector, there is a strong case for policy-makers to support these groups in providing access to life-saving health care among the poor.
... In Andhra Pradesh state of India, women credit group members made significantly more use of health insurance than nonborrowing women who have obtained the insurance through their husbands (Rai and Ravi, 2011). A pilot project in Bangladesh integrating a micro-credit programme for poor women with an essential service package resulted in significant increase in contraceptive use, and a decline in fertility (Amin et al., 2001). ...
The main contributors to inequities in health relates to widespread poverty. Health cannot be achieved without addressing
the social determinants of health, and the answer does not lie in the health sector alone. One of the potential pathways to
address vulnerabilities linked to poverty, social exclusion, and empowerment of women is aligning health programmes with empowerment
interventions linked to access to capital through microfinance and self-help groups. This paper presents a framework to analyse
combined health and financial interventions through microfinance programmes in reducing barriers to access health care. If
properly designed and ethically managed such integrated programmes can provide more health for the money spent on health care.
... Obviously, the number of children in the household determines the potential supply of child labour, and hence fertility behavior is a determinant of the supply of child labour. Amin et al. 2001 examine the impacts of microcredit with and without health care facilities. They observed that women who have access to health care with microinsurance significantly increase contraceptive use and therefore, a decline in fertility. ...
This research aims to discover whether access to microinsurance might make any difference to the microcredit receivers in terms of reducing their use of child labour. The research decomposes households into three broad groups: microcredit participants with microinsurance, microcredit participants without microinsurance and non-participants of microcredit and microinsurance. Using household information in Monga (flood) prone areas in Bangladesh, we use regression models to examine determinants of child labour for the different groups of households. The households in the flood prone regions are forced to implement coping strategies like skipping meals, using child labour, or using microcredit services. In extremly poor households quasi health and/or micro-life insurance in combination with microcredit has a significant effect of reducing the child labour supply, however, credit-life insurance has no significant influence. On the other hand, taking advanced payment from the employer or landlord has a highly significant positive impact on child labour supply. In moderately poor households microinsurance does not make any difference in determining child labour, microcredit has a strong negative influence on the child labour supply, no matter who are the clients of microinsurance. Micro finance has no role in determining child labour in the group of above poverty households, only decision maker's schooling and child's schooling are important determinants of child labour. Therefore, policy considerations should be made not only to provide adequate microcredit to extremly poor households but also to address the issue of microinsurance to protect against the high social opportunity cost of using child labour.
... Findings reveal no significant improvement in quality of life related to medical consumption, nutritional intake, and social participation. The implication is that at present there is little awareness, financial ease, and personal willingness of women users to invest in significant areas related to nutrition and health for self and household, contradicting the sugges-tion of some analysts (Amin, St Pierre, Ahmed, & Haq, 2001). Findings highlight that awareness for health and nutritional needs of women client must be raised to improve health quality of life, reproductive health, girl-child health, and old-age health. ...
Abstract
The present study aimed to examine improvements in the quality of life of women utilizing microfinance in urban Lahore, Pakistan. Random sampling was used to identify 5 microfinance providers in the region, and at a second stage of the study, quota sampling was used to interview 149 women users from microfinance site
offices. A questionnaire was developed to measure quality of life in four categories: economic, family, health, and decision-making ability. Data was analyzed through the mixed methods approach of reporting descriptive statistics with user comments and use of multivariate regression analysis. Findings reveal that majority women users of microfinance are poor, illiterate, and employed as unskilled labor. Of significance is that some non-economic variables of quality of life were evidenced to improve after loan-taking. Multivariate logistic regression was performed to obtain an odds ratio of relationships between loan portfolio characteristics and improved quality of life. It was evidenced that group borrowing, use of loan for self, not taking loan repayment assistance from household members, attending
monthly meetings, and receiving skill and development training all displayed higher odds of improved quality of life in women users. It is recommended that microfinance service provision should not be limited to financial services and should include urgent and compulsory social development features for women clients.
... Effect estimates suggest that, relative to a matched comparison group, IMAGE participants experienced a 55 percent reduction in the past year experience of physical and/or sexual intimate partner violence (Pronyk et al., 2006). In Bangladesh, participation in a microcredit forum is seen to have a significant positive effect on maternal knowledge of prenatal care (Hadi, 2001) and increase in contraceptive use with decline in fertility (Amin, St Pierre, Ahmed, & Haq, 2001). It is observed that health education alone, usually delivered during the routinely scheduled microfinance group meetings, can improve knowledge leading to positive health-related behavioural change (Leatherman & Dunford, 2010). ...
Microfinance is the provision of financial services for the poor. Health program through microfinance has the potential to address several access barriers to health. We report the design and baseline findings of a multi-site non-randomized evaluation of the effect of a health program on the members of two microfinance organizations from Karnataka and Gujarat states of India. Villages identified for roll-out of health services with microfinance were pair-matched with microfinance only villages. A quantitative survey at inception and twelve months post health intervention compare the primary outcome (incidence of childhood diarrhea), and secondary outcome (place of last delivery, toilet at home, and out-of-pocket expenditure on treatment). At baseline, the intervention and comparison communities were similar except for out-of-pocket expenditure on health. Low reported use of toilet at home indicates the areas are heading towards a sanitation crisis. This should be an area of program priority for the microfinance organizations. While respondents primarily rely on their savings for meeting treatment expenditure, borrowing from friends, relatives, and money-lenders remains other important source of meeting treatment expenditure in the community. Programs need to prioritize steps to ensure awareness about national health insurance schemes, entitlement to increase service utilization, and developing additional health financing safety nets for financing outpatient care, that are responsible for majority of health-debt. Finally we discuss implications of such programs for national policy makers.
... Microfinance schemes have proven particularly effective in supporting health provision. Research suggests that microfinance schemes improve knowledge and facilitate positive health behavioural change in both maternal and child health and infectious disease programmes (32)(33)(34)(35)(36)(37)(38)(39)(40). Careful design, implementation and evaluation of intersectoral programmes are required to link microfinance and health as an innovative response to the ongoing challenges of poverty, social exclusion and chronic disease (32,34). ...
... Although much research has been done on the effectiveness of micro-credit programs in improving the economic situation of women (Fernando, 1997;Schuler et al., 1997;Mayoux, 1999;Ahmed et al., 2001;Amin et al., 2001;Perry, 2002;Pitt et al., 2003;Izugbara, 2004), the findings have been inconclusive. As earlier pointed out, Pitt et al. (2003) found that women's participation in microcredit programs did increase their empowerment. ...
This paper seeks to examine the perceptions and experiences of Nigerian Esan women who participated in Better Life for Women Program, a poverty alleviation program. Between January and June 1994, we conducted in-depth interviews with twenty members of two micro credit groups based in Ekpoma and Ubiaja. The data showed that the distance between their place of residence and the financial institutions, spouses' control over their income, the use of force and threat of prosecution by the government and financial institutions hindered regular loan repayments. The findings are indications that culture practices and expectations negatively impact on poverty alleviation programs.
... Substantial inequities exist both for the use of facility-based basic obstetric care and for home births with skilled attendants [21,22,24,25]. Bangladesh has witnessed a relatively substantial expansion of maternal health interventions by both the government and nongovernmental organizations in rural areas [17,26,27]. The key question remains whether these interventions have resulted in a corresponding increase in uptake of these services by poor women. ...
Background
Evidence from low and middle income countries (LMICs) suggests that maternal mortality is more prevalent among the poor whereas access to maternal health services is concentrated among the rich. In Bangladesh substantial inequities exist both in the use of facility-based basic obstetric care and for home births attended by skilled birth attendant. BRAC initiated an intervention on Improving Maternal, Neonatal, and Child Survival (IMNCS) in the rural areas of Bangladesh in 2008. One of the objectives of the intervention is to improve the utilization of maternal and child health care services among the poor. This study aimed to look at the impact of the intervention on utilization and also on equity of access to maternal health services.
Methods
A quasi-experimental pre-post comparison study was conducted in rural areas of five districts comprising three intervention (Gaibandha, Rangpur and Mymensingh) and two comparison districts (Netrokona and Naogaon). Data on health seeking behaviour for maternal health were collected from a repeated cross sectional household survey conducted in 2008 and 2010.
Results
Results show that the intervention appears to cause an increase in the utilization of antenatal care. The concentration index (CI) shows that this has become pro-poor over time (from CI: 0.30 to CI: 0.04) in the intervention areas. In contrast the use of ANC from medically trained providers has become pro-rich (from, CI: 0.18 to CI: 0.22). There was a significant increase in the utilisation of trained attendants for home delivery in the intervention areas compared to the comparison areas and the change was found to be pro-poor. Use of postnatal care cervices was also found to be pro-poor (from CI: 0.37 to CI: 0.14). Utilization of ANC services provided by medically trained provider did not improve in the intervention area. However, where the intervention had a positive effect on utilization it also seemed to have had a positive effect on equity.
Conclusions
To sustain equity in health care utilization, the IMNCS programme needs to continue providing free home based services. In addition to this, the programme should also continue to provide funding to bear the cost to those mothers who are not able to have the comprehensive ANC from medically trained providers.
The Trump administration reinstated and expanded the Mexico City Policy (MCP) in 2017 as the Protecting Life in Global Health Assistance (PLGHA) policy, forbidding international organizations receiving all U.S. health assistance from promoting abortion. Existing evidence suggests that abortion rates rise under the MCP, but the direct effect of U.S. funding restrictions on supply and use of family planning has received less attention. By studying PLGHA’s impact on health service delivery providers and women in eight sub-Saharan African countries, we are able to fill this gap. We find that health facilities provide fewer family planning services, including emergency contraception, and that women are less likely to use contraception and more likely to have given birth recently under the policy. These findings suggest that PLGHA has important unintended consequences that are detrimental to reproductive health and the autonomous decision-making of health service providers and women.
Microfinance is showing great promise as a means of combating poverty in India. Although making significant contributions to the home and national economies, women's work is often undervalued or ignored. The rapid growth of SHGs and the Bank linkage model have sparked a nationwide campaign to increase women's economic independence. Many empirical investigations have demonstrated that the members of SHGs have been able to better their socioeconomic situation thanks to microfinance provided via SHGs and the Bank linkage model. Moreover, it empowers women to make better financial decisions for their families and boosts their self-esteem. The questionnaire serves as the primary data collector, while non-parametric tests (such as the chi-square and analysis of variance) are used for analysis and presentation. Self-help Training of Swarozgaris, infrastructure development, marketing and technology support, member communication, member self-confidence, reduction in family violence, increase in outsider contact, monthly savings by SHG members, monthly savings by SHG members as a whole, political participation, social harmony, social justice, and community involvement are just some of the areas where groups have made a significant impact.
Background: Post-partum family planning (PPFP) within first 12 months of childbirth is known to improve maternal and neonatal health outcomes. This study evaluates the effect a package of PPFP interventions in improving level of awareness, knowledge and practices of post-partum women. Methods: A before and after intervention cross sectional study was conducted in 18 public health facilities and their catchment areas across 5 districts of Bihar. Participants included randomly selected postpartum women and purposively selected health service providers. A standard questionnaire was used to assess the level of knowledge, awareness and practices related to post-partum family planning before and after the intervention. Results: A total of 972postpartum women,27 doctors, 46 nurses, 89 Auxiliary Nurse Midwives (ANM) and 89 Accredited Social Health Activists (ASHA) as well as 981 postpartum women, 18 doctors, 53 nurses, 90 ANMs and 90 ASHAs were interviewed during baseline and end line respectively. This intervention package increased knowledge regarding postpartumreturn to fertility, modern FP methods and criteria of lactational amenorrhoea method. Also, the proportion of post-partum women who reported receiving FP counselling were increased. Conclusion: The findings of this study demonstrate that effective implementation of a package of PPFP interventions at a scale can lead to improvement in the knowledge and awareness levels of both health workers and post-partum women.
A wide range of financial inclusion programmes seek to increase poor people’s access to financial services to enhance the welfare of poor and low-income households in low- and middle-income countries. The impacts of financial inclusion interventions are small and variable.
Although some services have some positive effects for some people, overall financial inclusion may be no better than comparable alternatives, such as graduation or livelihoods interventions.
Impacts are more likely to be positive than negative, but the effects vary, are often mixed, and appear not to be transformative in scope or scale, as they largely occur in the early stages of the causal chain of effects. Overall, the effects of financial services on core economic poverty indicators such as incomes, assets or spending, and on health status and other social outcomes, are small and inconsistent. Moreover, there is no evidence for meaningful behaviour-change outcomes leading to further positive effects. The effects of financial services on women’s empowerment appear to be generally positive, but they depend upon programme features which are often only peripheral or unrelated to the financial service itself (such as education about rights), cultural and geographical context, and what aspects of empowerment are considered. Accessing savings opportunities appears to have small but much more consistently positive effects for poor people, and bears fewer downside risks for clients than credit.
The weak effects found warn against unrealistic hype for financial inclusion, as previously happened for microcredit. There are substantial evidence gaps, notably studies of sufficient duration to measure higher-level impacts which take time to materialize, and for specific outcomes such as debt levels or indebtedness patterns and the link to macroeconomic development.
Purpose
The purpose of this study is to examine the impact of interest free micro credit loans on the lives and business of the female borrowers.
Design/methodology/approach
Both primary and secondary data have been used. Case studies of four different female entrepreneurs have been included as part of the research. The observation was conducted over an extended period of time. Subsequently, interviews were conducted with four beneficiaries to know the role played by interest free micro credit loans in improving (or not!) their lives and businesses.
Findings
Interest free micro credit loans played a significant role in bringing a positive change in the lives of the borrowers. Clients mentioned that “zero interest rate” and “flexible repayment schedules” were the main reason for obtaining loans from this source. Further, they suggested that there is a need for training/workshops, feedback/monitoring, networking and online repayment system to make interest free micro credit loans more successful.
Research limitations/implications
The focus of the study is limited to only four female borrowers in Karachi. Future studies can include other cities and cross-gender comparisons for better understating.
Practical implications
This study will help microfinance organizations to assess the problems faced by the borrowers; it will also shed light on the motivations of borrowers.
Originality/value
Interest free micro credit loans were provided to women entrepreneurs in a social experiment and implications were observed.
In rural northern Tanzania, 89 percent report wanting to delay or prevent pregnancy, yet only 12 percent of women are using contraceptives. This study uses a randomized experiment to evaluate the effect of an informational family planning program on couples fertility behavior. I estimate the effect of asymmetric spousal information, randomizing the inclusion of husbands in household consultations about family planning. I interact the effect with baseline levels of intimate partner violence to explore the way abuse changes the effect of family planning information. I find that the informational treatment had a significant effect on pregnancy reduction. In this context where men have much larger fertility desires than their wives, I find that women who consulted with a family planning worker together with their husbands (rather than alone) experienced a larger reduction in pregnancies and a larger increase in reported contraceptive use. However, this effect is reversed for women who experience intimate partner violence; for these women, participation in the couples consultations resulted in significantly more pregnancies at endline. This research supports the effectiveness of including husbands in sexual health consultations while demonstrating the need for careful consideration of intimate partner violence in family planning interventions.
Until recently, digitally enabled Knowledge Management (KM) activities in developing countries have more often than not been dismissed as unrealistic given challenges with access to electricity and the internet. However, a number of recent examples of holistic KM activities, including digital elements, have demonstrated a measurable contribution to improved outcomes for some of the world’s poorest people. This chapter focuses on such a case, looking at how a digitally enabled KM program was designed, piloted, and measured in two districts in Bangladesh. The program aimed to help rural community-based health workers be more informed about, and helpful in, providing health and nutrition guidance to some of the world’s poorest people.
Background:
Solutions delivered within firm sectoral boundaries are inadequate in achieving income security and better health for poor populations. Integrated microfinance and health interventions leverage networks of women to promote financial inclusion, build livelihoods, and safeguard against high cost illnesses. Our understanding of the effect of integrated interventions has been limited by variability in intervention, outcome, design, and methodological rigour. This systematic review synthesises the literature through 2015 to understand the effect of integrated microfinance and health programs.
Methods:
We searched PubMed, Scopus, Embase, EconLit, and Global Health databases and sourced bibliographies, identifying 964 articles exclusive of duplicates. Title, abstract, and full text review yielded 35 articles. Articles evaluated the effect of intentionally integrated microfinance and health programs on client outcomes. We rated the quality of evidence for each article.
Results:
Most interventions combined microfinance with health education, which demonstrated positive effects on health knowledge and behaviours, though not health status. Among programs that integrated microfinance with other health components (i.e. health micro-insurance, linkages to health providers, and access to health products), results were generally positive but mixed due to the smaller number and quality of studies. Interventions combining multiple health components in a given study demonstrated positive effects, though it was unclear which component was driving the effect. Most articles (57%) were moderate in quality.
Discussion:
Integrated microfinance and health education programs were effective, though longer intervention periods are necessary to measure more complex pathways to health status. The effect of microfinance combined with other health components was less clear. Stronger randomized research designs with multiple study arms are required to improve evidence and disentangle the effects of multiple component microfinance and health interventions. Few studies attempted to understand changes in economic outcomes, limiting our understanding of the relationship between health and income effects.
Improving livelihoods through entrepreneurship activities and program implementation are increasingly considered as key drivers for enhancing health of the participants and reducing their proneness to diseases. Combined programs of entrepreneurship and health education have yet to be widely applied to the practice of promoting sexual health. However, there has been the emergence of small projects focused on both financial and educational aspects of sex workers. The objective of these programs is to favor the empowerment of vulnerable groups through skills training in order to decrease sexual risk among them. Considering the well-known structural links between poverty and HIV/AIDS, combined micro-enterprise development and health educational programs have been implemented among sex workers in order to reduce the risk of HIV/AIDS among these categories of women. This article aims to explore the potential of these combined programs of entrepreneurship and health education to create new models and strategies to improve sexual health among groups at greatest risk of infection such as the sex workers in Phnom Penh, Cambodia.
The results of the meta-analysis indicated that the effect sizes from experimental studies examining effects of microcredit on women’s control over household spending are not statistically significantly different from zero. The effects from quasi-experimental studies are statistically insignificant overall, and at best of small magnitude for those studies assessed of being of high risk of bias. We conclude that there is no consistent evidence for an effect of microcredit on women’s control over household spending.
In the qualitative analysis, using Coleman’s (1986, 1990) typology of mechanisms, we identified five different situational mechanisms and eight different action-formation mechanisms. Due to the combination of substantial heterogeneity in contexts (e.g. existing gender relations) and interventions (e.g. microcredit versus microcredit and additional services), and the lack of information in the studies on this heterogeneity, it was not possible to go beyond the identification of mechanisms, in terms of generating empirically tested articulated theories of change which are representative beyond a specific study context.
AUTHORS’ CONCLUSIONS
In line with three recent other reviews on microfinance (Stewart et al., 2010; Duvendack et al., 2011; Stewart et al. 2012) we found that the microcredit evidence base is extensive, yet most studies are weak methodologically. From those studies deemed comparable and of minimum acceptable quality, we concluded that overall there is no evidence for an effect of microcredit on women’s control over household spending.
Women’s control over household resources constitutes an important intermediary dimension in processes of women’s empowerment. Given the overall lack of evidence for an effect of microcredit on women’s control over household resources it is therefore very unlikely that, overall, microcredit has a meaningful and substantial impact on empowerment processes in a broader sense. While impacts on empowerment may appear to have occurred in particular studies, the high risk of bias of studies providing positive assessments suggests that such findings are of limited validity. Our conclusions on the effects of microcredit on empowerment are also in line with previous systematic reviews by Duvendack et al. (2011) and Stewart (et al. 2010) who report to a limited extent on empowerment effects. Consequently, there appears to be a gap between the often optimistic societal belief in the capacity of microcredit to ameliorate the position of women in decision-making processes within the household on the one hand, and the empirical evidence base on the other hand.
However, our review markedly differs from previous reviews in two regards. First, we specifically focused on microcredit and women’s empowerment captured through women’s control over household expenditures. Second, as a result of this narrower focus, we were able to conduct statistical meta-analysis and extract behavioral mechanisms which can help to explain why and how microcredit can make a difference. The advantage of our approach was that the identified mechanisms all stem from studies which show evidence of addressing the attribution problem. Consequently, we can be quite confident of the insights that they provided on the effects of microcredit on women’s control over household spending for particular populations of microcredit female clients and their families.
Those studies that showed evidence of addressing the attribution problem were relatively weak on underlying theory. Moreover, they often lacked essential information such as the nature of the intervention and how it related to empowerment (e.g. how solidarity groups affect empowerment processes) or the slowly evolving gender relations in different contexts (e.g. the evolution of societal norms and the relationship with power relations in the household). A next logical step would be to undertake a systematic review of qualitative studies which often provide rich and context-specific information on microcredit and women’s decision-making power in the household. Such a review should ideally build on the mechanisms identified in the present review and would bring us closer to uncovering credible theories of microcredit and the circumstances in which it may change women’s decision-making power.
Microfinance (MF) and family planning (FP) are thought to be very important interventions in the promotion of human development and it has been suggested that MF has significant beneficent impacts on contraceptive adoption and fertility. Thus, several authors, e.g. Amin, Hill and Li (1995), Amin et al (1994 and 2001); Schuler, Hashemi and Riley (1997); Hashemi, Schuler and Riley (1996); Schuler and Hashemi (1994), using naive methods find that MF in Bangladesh increases contraceptive use and reduces fertility at the individual level, largely because MF empowers women. Pitt et al (1999) – henceforth PKML), however, using instrumental variables (IV) estimation find that MF is associated with decreases in contraceptive use especially when females borrow, and male borrowing decreases fertility, perhaps because fertility increasing income effects of MF outweigh substitution. Steele et al (2001), also using data from Bangladesh from around the same time as the PKML study, come to conclusions closer to the orthodoxy, arguing that PKML use an inappropriate metric for MF programme participation. In this paper we apply matching methods to our reconstruction of the PKML data to test whether other methods reproduce their results. We find that female borrowing substantially increases contraceptive use but has mainly no effects on fertility, while male borrowing has no effect on contraceptive use or on fertility; this contradicts some of the findings of PKML. Our results are shown to be vulnerable to unobservables, but there is no reason to believe that results on IV based methods are more reliable.
This article examines how poor rural families in India cope with the food insecurity associated with seasonal troughs in the agricultural production cycle, and with calamities such as drought and famine; the effectiveness of the coping mechanisms they adopt; the intra‐household sharing of the burden of coping; and the appropriate state and non‐state interventions that would strengthen the survival mechanisms adopted by the families themselves. The family is seen here as a bargaining unit, the ability of different members to command food (among other resources) depending on their relative bargaining strengths, determined in turn by their ownership endowments (of land, labour, etc.), exchange entitlements, and external social and communal support systems. Gender and age both form the basis of intra‐family inequality in this respect. While seasonality reveals a face of the family which is one of co‐operation, famine mirrors one of disintegration. In both contexts, the burden of coping falls disproportionately on female members within poor households, traceable to women's already weak and further weakened (during calamity) bargaining position within the family. A re‐interpretation of existing facts about the 1943 Bengal famine illustrates the process of family disintegration and the abandonment of wives and children during a severe calamity. State efforts complemented by non‐state interventions therefore need to be directed to programmes that ‘empower’ poor families and the more vulnerable members within them.
Incl. abstract, bibliographical references
Two books attempt to assess the achievements of microenterprise finance institutions from a comparative point of view. This first volume offers an in-depth analysis of the theory as well as policy recommendations for practitioners in the field. The authors consider why development finance institutions exist; why credit markets fail the poor; financial performance and sustainability, the role of innovative credit institutions in the market place; the impact on production and technology; impacts on poverty, vulnerability and deprivation; the politics of financial intermediation for the poor; the management of financial institutions for the poor; and growth versus equity.
Providing microcredit to the poor has become an important antipoverty scheme in many countries. Microcredit helps the poor become self-employed and thus generates income and reduces poverty. In Bangladesh, these programs reach about five million poor households. But microcredit programs are just one of many ways of reducing poverty. Are these programs cost-effective? This book addresses the question, drawing on the experiences of the well-known microcredit programs of Bangladesh's Grameen Bank, the Rural Development-12 project, and the Bangladesh Rural Advancement Committee. It examines the cost-effectiveness of microcredit programs vis-a-vis other antipoverty programs, such as Food-for-Work. Does the gender of program participants matter? This book uses extensive household survey data to address how the gender of participants affects the impact of microcredit programs.
This article examines the concept of reproductive health as it emerged in the 1980s, its consequences for health research and family planning programmes in India, its advocacy for the third world agenda and the reasons behind it, its epidemiological basis, and offers an alternative public health perspective for understanding reproductive health.
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Programs that support poor women's income earning can use four measures of effectiveness. These are: meaningful, sustainable increases in income levels for large numbers of participants; policy and regulatory changes that expand economic choices for the poor; increases in aggregate employment, economic growth, and diversification of the local economy; and “empowerment”—evidence that women mobilize and gain more control over their social, political, and economic lives. Using these criteria, the paper analyzes the strengths and weaknesses of three strategies for addressing the problems of self-employed individuals and microenterprises: the area-, sector-, and function-focused approaches. It concludes that the sector- and function-focused strategies offer the most promise for helping women to make significant economic gains and deserve further experimentation and donor support.
A growing number of non-governmental organizations (NGOs) are adopting the collateral-free credit programs by anchoring them with their social development programs aimed at improved program effectiveness and sustainability. Drawing upon a sample of 3,564 targeted poor households covered by five small NGOs in rural Bangladesh, this study finds that the NGO credit-members as well as those who reside in the NGO program area are higher adopters of child immunization than those in the non-program area. Similarly, the study found that infant and child mortality is lower among the NGO credit members than among the non-members and that under five-year deaths of children progressively decline with the increase in the doses of vaccines. Implications of these findings are discussed in the study.
A growing number of NGOs in rural Bangladesh are reaching out to a vast multitude of poor women with collateral-free credit programs either by integrating them with their preexisting social welfare programs or by adding the welfare programs to the credit programs, thus providing a comprehensive range of services including consciousness-raising, functional literacy training, and group formation. It has been argued that the provision of such an integrated range of socioeconomic services not only reinforces the social and economic well-being or the poor women, but also empowers them. The data of the present study suggest that women's membership in NGO-promoted credit programs, their residence in an NGO program area and in nonsouthern and noneastern regions, their higher socioeconomic status, and their age tend to be positively associated with women's empowerment. Our indices of women's emplowerment are found to be significantly and positively associated with NGO credit membership and residence in an NGO program area. This significant positive relationship of women's emplowerment indices with NGO credit membership may stem from the poor women's participation in an NGO credit program.
This analysis pertains to an examination of fertility trends, differences, contraceptive use, and fertility preferences in Bangladesh. Data were obtained from the 1969 National Impact Survey of Family Planning; the 1975 and 1989 Bangladesh Fertility Surveys; and the 1983, 1985, and 1991 Contraceptive Prevalence Surveys. Age specific fertility rates (ASFR), current pregnancy rates, and the mean number of children ever born (CEB) are the estimated fertility measures. The P/F ratios show a significant fertility decline since 1983. Total marital fertility declined from 7 births in the 1960s to 5.2 in the late 1980s. The average number of CEB declined from 4.3 in 1969 to 3.7 in 1991. The percentage of pregnant women declined from 13.3 to 10.6. The ASFR declined primarily among older married women. Fertility declined among all groups including landowners and landless, the educated and the uneducated, rural and urban populations. The extent of decline varies by group. The total marital fertility rate (TMFR) declined more for the educated and the urban populations. Chittagong region had the higher fertility regardless of the period. TMFR was lower among contraceptive users compared to nonusers. The increase in contraceptive use was from 4 to 40% between 1969 and 1991. The following factors affected the extent of fertility decline: contraceptive use, reduced child mortality concomitant with extended lactation and amenorrhea, increased malnutrition, and/or improvements in child survival. Fertility was depressed under conditions of increased poverty, which may stimulate contraceptive use and lead to malnutrition and subfecundity. The higher Chittagong fertility pattern is not explained by regional comparisons of pregnancy wastage, stillbirths, and induced abortion. Desire for no more children increased from 46 to 58% during 1969-91. The average preferred family size is declining. High density and deep-seated poverty explain fertility decline in regions other than Chittagong. Demand for contraception may increase with increases in family planning home visits and educational opportunities.
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