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RES E AR C H Open Access
The effect of Self-Help Groups on access to
maternal health services: evidence from rural
India
Somen Saha
1,2*
, Peter Leslie Annear
1
and Swati Pathak
3
Abstract
Introduction: The main challenge for achieving universal health coverage in India is ensuring effective coverage of
poor and vulnerable communities in the face of high levels of income and gender inequity in access to health care.
Drawing on the social capital generated through women’s participation in community organizations like SHGs can
influence health outcomes. To date, evidence about the impact of SHGs on health outcomes has been derived
from pilot-level interventions, some using randomised controlled trials and other rigorous meth ods. While the
evidence from these studies is convincing, our study is the first to analyse the impact of SHGs at national level.
Methods: We analyzed the entire dataset from the third national District Level Household Survey from 601 districts
in India to assess the impact of the presence of SHGs on maternal health service uptake. The primary predictor
variable was presence of a SHG in th e village. The outcome variables were: institutional delivery; feeding new-borns
colostrum; knowledge about family planning methods; and ever used family planning. We cont rolled for
respondent education, wealth, heard or seen health messages, availability of health facilities and the existence of a
village health and sanitation committee.
Results: Stepwise logistic regression shows respondents from villages with a SHG were 19 per cent (OR: 1.19, CI: 1.13-1.24)
more likely to have delivered in an institution, 8 per cent (OR: 1.08, CI: 1.05-1.14) more likely to have fed newborns
colostrum, have knowledge (OR: 1.48, CI 1.39 – 1.57) and utilized (OR: 1.19, CI 1.11 – 1.27) family planning products and
services. These results are significant after controlling for individual and village-level heterogeneities and are consistent with
existing literature that the social capital generated through women’s participation in SHGs influences health outcome.
Conclusion: The study concludes that the presence of SHGs in a village is associated with higher knowledge of family
planning and maternal health service uptake in rural India. To achieve the goal of improving public health nationally, there
is a need to understand more fully the benefits of systematic collaboration between the public health community and
these grassroots organizations.
Keywords: Self help group, Institutional delivery, Family planning, Barriers, India
Introduction
As India strives to achieve universal health coverage, the
main challenge is to expand coverage to all citizens with
protection from the costs of basic health services. The
poor generally have worse health outcomes and access to
care compared to the non-poor. Poor health contributes
to the persistence of India’s high poverty rates, with health
expenditures driving 39 million families into poverty each
year [1]. Even when treatment is sought, significantly
smaller sums of money are spent on treatment of women
than on men [2]. Gender discrimination exists in child
feeding, health care, and nutrition status in India [3-9],
and other South Asian countries [10,11].
Overcoming barriers to health service access is likely
to be more difficult for the poor and other vulnerable
groups as the costs of care, lack of information and
cultural barriers impede them from benefiting from
* Correspondence: somens@student.unimelb.edu.au
1
Nossal Institute for Global Health, The University of Melbourne, Level 4,
Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3010, Australia
2
Indian Institute of Public Health Gandhinagar, Drive in Road, Thaltej,
Ahmedabad, Gujarat 380054, India
Full list of author information is available at the end of the article
© 2013 Saha et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Saha et al. International Journal for Equity in Health 2013, 12:36
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public spending [12,13]. Factors such as poverty, inad-
equate housing and lack of education are the social root s
of morbidity in developing countries [14]. Health ca nnot
be achieved without addressing these social determi-
nants of health, and the answer does not lie only in the
health sector [15-18]. Socioeconomic disparities are the
major determinants of population health [19].
In this paper we analyse the effect of social capital,
generated through women’s participation in community
networks known as Self-help Groups (SHGs), on access
to maternal health services, using data available from a
large national survey in India. SHGs have emerged as a
development strategy having a primary focus on poverty
alleviation and empowerment of women. Structurally, a
SHG is a small economically homogeneous affinity
group of the rural poor coming together to form savings
and credit organizations. Members deposit an amount
regularly in a common fund to meet emergency needs
and to provide collateral free loans decided by the group
[20]. These small groups (10–20 members each) of pre-
dominantly rural women are well established in the
country. Meeting the need for access to capital, specific-
ally articulated by women during the United Nation’s
Conference on Women and Development in Mexico
City in 1975, SHGs can, in many ways, be considered
the cornerstone of much of the well-established
microfinance activity in India. Katz [21] defined self-help
groups as: “Voluntary, small group structures for mutual
aid and the accomplishment of a special purpose”. They
are usually formed by peers who have come together for
mutual assistance in satisfying a common need, over-
coming a common handicap or life-disrupting problem,
and bringing about desired social and/or personal
change. They often provide material assistance, as well
as emotional support; they are frequently cause-oriented
and promulgate an ideology or values through which
members may attain an enhanced sense of personal
identity.
Major NGOs like the Self Employed Women’s Associ-
ation, BRAC (a major development organization), and
Grameen Bank in Bangladesh have engaged extensively
in promoting health related activities through SHG par-
ticipation. In India, organizations based on the Gandhian
philosophy of self-reliance had already been popularized
during the freedom movement in British India [22].
SHGs reflect a similar philosophy and provide an avenue
for poor rural women to access the microcredit syste m.
In the early 1990s, policymakers in India took notice of
SHG growth and influence and established a country-
wide SHG Bank Linkage Programme (SBLP). SBLP, pro-
moted aggressively by the National Bank for Agriculture
and Rural Development, links mature SHGs with the
formal banking system. SHGs are linked to Regional
Rural Banks (RRB), commercial banks and cooperative
banks to access microcredit as a source of additional
capital for the group members to supp lement their sav-
ings. By establishing the Swarnajayanti Gram Swarojgar
Yojana in 1999, the Government of India aimed to pro-
vide self-employment to millions of villagers. Poor fam-
ilies living below the poverty line were then organized
into SHGs established with a mixture of government
subsidy and credit from investment banks.
The main aim of these SHGs is to focus on income
generation and raising poor families above the poverty
line. The SHGs are supported and trained by non-
government organizations (NGOs), community based
organizations (CBOs), individuals, banks self-help pro-
moting institutions, and microfinance institutions (MFI).
The most prominent models of delivery for microfinance
in India continue to be SHGs, promoted by the state
governments, NGOs, a few regional rural banks, and
specialized MFIs that use various models to make both
group and individual loans [23]. The southern states of
India experienced the largest concentration of SHG
activities, both with state support, and promoted by
private MFIs (Figure 1).
Access to Health and SHG
The nature of SHG activities, where memb ers meet
regularly for transactions and training, creat es solidarity
and social capital. Social capital is built on features of
social organization, such as trust, social norms and
networks, that can improve the efficiency of society by
facilitating coordinated actions [24]. The concept of so-
cial capital is further split into three connecting strands:
bonding social capital (i.e. ties between immediate family
members, neighbours and close friends); bridging social
capital (i.e. ties between people from different ethnic,
geographical, and occupational backgrounds); and linking
social capital (i.e. ties between poor people and those in
positions of influence in formal organizations such as
banks and schools) [25]. SHGs, which bring village
women together in a common organization for mutual
support, are mobilized by existing bonding social capital,
and then build linking social capital as the group members
get involved in activities [26].
Several studies have found an association between social
capital, generated from participation in microfinance,
SHG, and participatory women’s groups on diverse health
behaviours and health outcomes, as well as reducing
inequity.
Globally there is emerging evidence to show that
microfinance programmes have created non-financial
benefits including improvements in health, hygiene and
sanitation [19,27,28]. In post-tsunami Sri Lanka , a study
using retrospective panel data from 350 randomly
selected borrowers showed that microfinance loans pro-
vided after the disaster were instrumental in reducing
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the income gap between those who were hit and those
who were not [29]. One analysis of a large dataset from
three waves of the Indonesian Family Life Survey,
showed a positive effect on changes in children’s health
as MFI members were twice as likely to live in urban
areas, have sewerage systems, regular garbage collection,
electricity and better access to medical facilities [30].
Studies in India and Bangladesh have shown the positive
effect of SHGs on reducing exclusion [31], improved
childcare and contraceptive use [32,33].
In Maharashtra state, a project that trained women
SHG members as health workers, initiated literacy
programmes and provided funds for household health
emergencies showed in the two decades after 1970 a
reduction in infant mortality from 176 to 19 per 1000, a
birth-rate decline from 40 to 20 per 1000, nearly universal
access to antenatal care, safe delivery, and immunization,
and a decline in rates of malnutrition from 40% to less
than 5% [34,35].
A clustered random ized trial was conducted to assess
the impact of a community mobilization progra mme
through participatory women’s group among the indi-
genous communities of Jharkhand and Odisha states of
India. The trial found newborn babies born to mothers
associated with a women’s group significantly improved
the likelihood of surviving within the first six weeks of
their lives, compared to babies born to analogous house-
holds in control communities [36].
While available evidences, that includes rigorous
randomised controlled trials and other rigorous methods,
suggests the positive effect of social capital in reducing in-
come gap, exclusion, saving newborn, and gender disparity
in access to healthcare, Nayar [22] noted that most of the
success stories from India are from large organization that
Figure 1 Villages in India with a SHG.
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incorporate self-help activities as part of other concurrent
interventions. There has not previously been an assess-
ment in India using nationally representative data.
The third round of the District Level Household Survey
(DLHS-3), a national health survey conducted in 2007–08
in 601 districts of India included a question on the
presence of a SHG in its village level questionnaire. Using
this data, we are able to analyze the effect of SHGs on the
knowledge and practices of women. This data provides
the best available opportunity to analyze the influence of
the presence of SHGs on women’sRCHknowledgeand
practices on a national scale. The results of our analysis
are reported in this paper.
Methods
Our study is the first to use national level data to analyse
the impact of SHGs on health outcomes. We made a
secondary analysis of data provided through the DLHS-3,
which has been made publicly available. We analysed the
national dataset, which was collected from 22,825 villages
through the village questionnaire and from 643,94 4 ever-
married women (15 – 49 years) through the ever-
married women’s questionnaire. The DLHS-3 adopted a
multi-stage stratified systematic sampling design that
produced representative samples at national and state
level after applying sampling weights to control for
complex survey design [37]. The DLHS-3 wa s designed
to provide information on family planning, maternal and
child health, reproductive health of ever-married women
and adole scent girls, and utiliz ation of maternal and child
healthcare services at the distric t level. At village level,
the DLHS-3 included questions about the presence of
SHGs in the village; unit level data from the village file
and data from the ever-married women file were merged
to conduct the analysis.
We analyzed the DLHS-3 dataset from 601 districts of
India. Our hypothesis is that the presence of a SHG in a
village is associated with improved access to maternal
health services. Members of the groups are predomin-
antly women, and maternal health indicators are good
proxy indicators for overall health access. In this paper
we have used four measures of women and child health
knowledge and practices: institutional delivery; feeding
new-born colostrum; knowledge about family planning
services; and use of family planning methods. We mea-
sured knowledge and use of family planning by women
who were aware of and practiced at least one of the
following methods: female sterilization, IUD, oral contra-
ceptive pills, emergency contraception and female con-
dom. Indicators were transformed into binary measures
by re-coding all ‘yes’ responses as 1 and ‘no’ as 0. For place
of delivery: deliveries at hospital, dispensary, urban health
centre/urban primary health centre, community health
centre/rural hospital, primary health centre, sub-center,
Ayush hospital/clinic, NGO/trust clinic, private hospital/
clinic and on-way-to-hospitals were re-coded as 1, and
delivery at home and work place were re-coded as 0. Data
analysis was done using SPSS Version 19.
Explantory and control variables
Pitt [38] identified three source s of bia s in estimating
cause-effect relationships: choice-based sampling, indi-
vidual heterogeneity bias , and village heterogeneity bias.
To address unmeasured individual and village attributes
that affect both programme participation and health out-
come, we instituted some controls. For individual hetero-
geneity we controlled for: respondent education (illiterate,
primary, middle and higher secondary and above), wealth
quintile, heard or seen health messages; and for village level
heterogeneity we controlled: accessibility of Community
Health Centre/Rural Hospital (CHC/RH), villages with any
beneficiaries of JSY in last one year, and health and
sanitation committee in village. Choice-based sampling is
addressed by the sample size, and the national nature of the
survey that can tease out the contribution of self-help
groups independent of other concurrent activities or the
organizational infrastructure. Table 1 shows the number
and percentage distribution of responses by selected
characteristics.
Table 1 Predictor and control variables used in the
analysis
Variable Percentage Number
Predictor variable
Village have SHG 57.9 13,211
Individual control variables
Heard or seen health messages 85.9 553,225
Wealth Quintile
Poorest 18.0 51,707
Second 21.9 62,996
Middle 25.0 71,732
Fourth 22.4 64,218
Richest 12.7 36,425
Mother’s level of education
Illiterate 46.7 300,526
Primary (1-7) 23.5 151,048
Middle (8-10) 20.0 128,739
Higher secondary and above (11+) 9.9 63,631
Village control variables
Health and sanitation committee in village 28.7 6,554
Accessible CHC/RH 77.4 16,609
Beneficiary of JSY 90.1 16,853
Numbers are unweighted.
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Statistical models
We computed forward stepwise logistic regressions
adding different levels of control variables to a base
model that regress our four outcome variables (institu-
tional delivery, feeding colostrum, knowledge of family
planning, and ever used family planning) on the avail-
ability of SHG in the village. We used a fixed effect
unique to a district that captures the time-invariant
differences across districts. For each of the four outcome
variables, three models were estimated. In Model 1, the
effect of presence or absence of a SHG in the village was
modelled. This model represented the total variance in
the four outcom e variables with the presence or absence
of a SHG. In Model 2 only individual level control
factors (respondent education, work status, and heard or
seen health messages) were included. In Model 3 indi-
vidual and village background controls: village electrifi-
cation, education facility available in the village, village
connected through an all-weather road, distance from
nearest hospital, beneficiaries of JSY in last one year, and
health and sanitation committee were included. All
models use survey weights to account for sample design
and population weighting and standard errors are
adjusted for clustering at the district level.
Thefocusoftheanalysiswasthechangeinthecoef-
ficient of the presence of a SHG. The results are shown
as odds ratios (ORs) with 95 per cent confidence
inter vals (CIs). The magnitude of the change was
interpreted a s the (exponentiated coefficient – 1.0) x
100. The small variance inflation factor of 1.09 (not
reported) indicated the absence of any significant co-
linearity b etween explanatory variables in the regres-
sion model.
Results
SHGs in India
As per DLHS-3 data, 57.9 per cent of Indian villages
have a self-help group (Figure 1). The majority of these
groups are located in southern and north-eastern India,
followed by Maharashtra, Chhattisgarh, Rajasthan and
Madhya Pradesh.
Descriptive statistics
The descriptive statistics (Figure 2) show some interest-
ing findings on the four measures of women and child
health knowledge and practices. The overall use of
family planning was found to be very low. The presence
of a SHG ha s a positive and strong correlation with all
four measures of knowledge and practices. Compared to
households in villages without a SHG, households in
villages with a SHG are more likely to go for institu-
tional delivery, more likely to feed new-borns colostrum,
and more likely to have knowledge of and use family
planning products and services. Members engaged in self-
help activity feel a sense of connectivity and discuss issues
ranging from place of delivery to feeding the baby and
family planning products and services.
Estimation results
As discussed in the methods sections earlier, we present
our results on four measures of maternal and child
health knowledge and practices: institutional delivery;
feeding new-born colo strum; knowledge about family
planning services; and ever used family planning.
Predictor of institutional delivery (Table 2): The pres -
ence of a SHG in a village is a ssociated with 19 per cent
higher odds of mother’s delivering in an institution (CI:
61%
84%
99%
65%
34%
73%
90%
55%
Institutional Delivery Feeding Colostrums Knowledge of Family Planning Ever used Family Planning
Characteristics of study variables in
villages with and without SHG
Yes No
Figure 2 Study variables in villages with and without SHG.
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1.13 – 1.24), holding other variables constant. The
reduction in odds from 1.30 to 1.19 in presence of indi-
vidual and village level controls indicates the influence
of other factors affecting the outcome. Model 2 adds
individual control. The coefficients of individua l control
variables illustrate that mot her’s education, wealth and
having heard or seen health messages are important me-
diating pathways to influence institutional delivery. At
the village level, the presence of a health and sanitation
committee in the village, accessibility of CHC/RH (OR:
1.16), and beneficiary of JSY (OR: 1.30) are important
mediating pathways that influence institutional delivery.
Predictor of feeding colostrum (Table 3): The presence
of a SHG in a village is associated with 8 per cent higher
odds of an increase in colostrum feeding. Mother’s edu-
cation, wealth, and having heard or seen health message
are important individual level mediating pathways, while
being a beneficiary of JSY (OR: 1.32) is an important vil-
lage level mediating factor predicting colostrum feeding.
The presence of a health and sanitation committee in a
village or accessibility of a CHC/RH does not appea r to
influence the outcome.
Knowledge about Family Planning (Table 4): House-
holds in villages with a SHG are at 48 per cent higher
odds of knowing at least one modern family planning
method. Model 1 produced an odds ratio of 2.13, indi-
cating the strong influence of having heard or seen
health messages in knowledge generation about family
planning. More educated and wealthy women are more
likely to have knowledge of family planning. Accessibility
of a CHC/RH, and having been a beneficiary of JSY are
village level variables influencing the outcome.
Ever-used family planning (Table 5): Presence of a
SHG is associated with 19 per cent higher odds of ever
using family planning. Women’s literacy does not show a
positive association with use of family planning, suggesting
the lack of empowerment and decision making on repro-
ductive choice. Wealth status, and heard or seen health
message are important individual level factors, while acces-
sibility of CHC/RH, and beneficiary of JSY are important
village level mediating pathways influencing use of family
planning.
Limitations
As information on women’s actual participation in SHG
activities was not included in the DLHS-3 dataset, our
analysis provides an instructive but partial picture of the
impact of SHGs on health outcomes. There are a
Table 2 Effect on institutional delivery
Institutional delivery Only predictor variable Individual control Full model
Presence of SHG 1.30 (1.27-1.33) 1.26 (1.19-1.28) 1.19 (1.13-1.24)
Mother’s education 1.52 (1.50-1.54) 1.52 (1.50-1.54)
Wealth quintile 1.53 (1.51-1.55) 1.51 (1.49-1.53)
Heard or seen health messages 1.80 (1.73-1.88) 1.79 (1.72-1.87)
Health and sanitation committee
in village
1.16 (1.12-1.19)
Accessible CHC/RH 1.16 (1.13-1.20)
Beneficiary of JSY 1.30 (1.25-1.36)
District fixed-effect Yes Yes Yes
N 138,068 138,068 138,068
Figures are odds ratio with 95% Confidence Interval.
Table 3 Effect on colostrums feeding
Colostrums feeding Only predictor variable Individual control Full model
Presence of SHG 1.20 (1.17-1.23) 1.09 (1.06-1.12) 1.08 (1.05-1.14)
Mother’s education 1.33 (1.31-1.36) 1.33 (1.31-1.36)
Wealth quintile 1.08 (1.07-1.10) 1.08 (1.07-1.10)
Heard or seen health messages 1.46 (1.41-1.51) 1.47 (1.42-1.53)
Health and sanitation committee in village 0.99 (0.96-1.02)
Accessible CHC/Rural Hospital 0.91 (0.88-0.95)
Beneficiary of JSY 1.32 (1.27-1.37)
District fixed-effect Yes Yes Yes
N 135,823 135,823 135,823
Figures are odds ratio with 95% Confidence Interval.
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number of limitations to our study. First , we did the
analysis at the aggregate country level. This masks varia-
tions in the spread and intensity of SHG activity across
India, as depicted in Figure 2 above. Secondly, the pres-
ence of a SHG in a village could only partially explain
the level of activity. The level of women ’s participation
in a SHG [39], the availability of credit [40] and the dur-
ation of association [31,41] are other key predictors of
health outcomes that the DLHS-3, due its limited scope
and intent , did not address. Thirdly, we also did not find
within the DLHS-3 manual an explicit definition of
SHGs , or any distinction between the possible imp act of
SHGs and other women’s or community groups. The
fourth limitation relates to the design and nature of the
DLHS-3, including its reliance on self-reported informa-
tion from respondents and the cross-sectional nature of
the survey, as described by Jat et al. [42]. The survey
collected the responses to the que stionnaire only at their
face value and had no opportunity to probe. Hence we
could examine only the association between explanatory
variables and four indicators of maternal health
ser vic es uptake; we were not able to draw conclusions
about causality. Nonetheless , ours is the first attempt
to analyse these issues using a nationally representative
dataset. Using this large national level d ataset allowed
us to address two importa nt biases re veale d in pre vi-
ous studies: choice based sampling [38] and teasing
out t he contribution of SHGs within the organiz ational
infrastructu re [22].
Discussion and conclusions
Using a large national health survey data set from India,
we examined the association between the presence of a
SHG and maternal health service uptake measured
through institutional delivery, feeding colostrum to new-
born, knowledge and use of family planning (after
controlling for individual and village level factors). Our
study shows respondents from villages with a SHG were
more likely to have delivered in an institution, fed new-
born with colostrum, and known about and utilized
family planning products and services. These groups give
the communities an avenue to voice their concerns and
provide a unique space in which solidarity is created
through promoting shared visions and goals and
combining collective strengths. The presence of trust
and social capital empowers communities and positively
influences individual and community health. However,
on their own, SHGs can have only limited impact. This
Table 4 Stepwise logistic regression of knowledge of family planning
Knowledge of family planning Only predictor variable Individual control Full model
Presence of SHG 2.13 (2.01-2.26) 1.54 (1.45-1.63) 1.48 (1.39-1.57)
Women’s education 1.11 (1.06-1.16) 1.11 (1.06-1.16)
Wealth quintile 1.44 (1.40-1.49) 1.43 (1.39-1.47)
Heard or seen health messages 9.35 (8.80-9.94) 9.23 (8.68-9.81)
Health and sanitation committee in village 1.03 (0.96-1.11)
Accessible CHC/RH 1.35 (1.27 -1.43)
Beneficiary of JSY 1.29 (1.18-1.40)
District fixed-effects Yes Yes Yes
N 397,055 397,055 397,055
Figures are odds ratio with 95% Confidence Interval.
Table 5 Stepwise logistic regression of using family planning
Ever used family planning Only predictor variable Individual control Full model
Presence of SHG 1.20 (1.13-1.28) 1.21 (1.14-1.29) 1.19 (1.11-1.27)
Women’s education 0.77 (0.75-0.80) 0.77 (0.75-0.80)
Wealth quintile 1.24 (1.21-1.29) 1.24 (1.20-1.27)
Heard or seen health messages 1.36 (1.16-1.59) 1.35 (1.16-1.59)
Health and sanitation committee in village 1.06 (0.99-1.14)
Accessible CHC/RH 1.12 (1.03-1.20)
Beneficiary of JSY 1.20 (1.08-1.34)
District fixed-effects Yes Yes Yes
N 19,143 19,143 19,143
Figures are odds ratio with 95% Confidence Interval.
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is explained by the relatively low odds ratio in presen ce
of individual and village level controls. Clearly, in order
to have maximum impact on community health, there is
a need for additional complementary health programmes
to build on the solidarity and social capital generated as
a result of the group.
The study adds to the evidence that trust, solidarity
and sense of belongingness as a result of participation in
a SHG are important determinants of health outcomes.
Additionally, by using a large national health survey
dataset, our study shows this effect is independent of
organizational infrastructure. There is a strong ca se for
policy makers to work closely with these groups and
leverage on their strengths for health improv ement and
poverty reduction.
By linking the activities of SHGs to broader programmes,
such as the National Rural Health Mission (NRHM),
Indian policy makers could increase the impact of these
proven interventions designed to provide improved access
to health care and address poverty. Programs like the
NRHM could effectively use the SHG community struc -
tures to promote awareness and generate increased
demand for services. The NRHM would benefit by linking
with the range of services provided in the community by
both the individual SHGs and their federated structure.
These services include creating community awareness,
promoting institutional delivery, childhood immunization,
preventive care and lay counselling through village health
and sanitation committees, community monitoring, emer-
gency health loans and health savings funds, and the
provision of low-cost health products, such as sanitary
napkins, contraceptive choices and first-aid care at the
community level. Even so, scaling-up such programmes to
national level must be based on reliable evidence related to
implementation procedures to avoid difficulties that were
previously experienced with the Jamkhed, Kakamega and
other similar experiments [34].
This has implications for low- and middle-income
countries where barriers to access to health services,
including informational and cultural barriers, prevent
poor and vulnerable groups from benefiting from public
health spending. With a global outreach to 205 million
microfinance members [43], these groups are an innova-
tive way to combine poverty alleviation and community
health interventions into an integrated strategy that
leverages existing resources to achieve greater impact
and scale. Finally we conclude that to achieve the goal of
improving public health, there is a need to better under-
stand the benefits of systematic collaboration between
the public health community and these grassroots
organizations.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
SS led the drafting of the manuscript, and contributed to all aspects of the
study. PA participated in conceptualization of the study design, and advised
on most aspect of the study. SP provided support for statistical analysis, and
drafted part of the manuscript. All authors have read and approved the final
manuscript and declare no competing interest.
Acknowledgement
The research is supported by a Research Higher Degree grant from the
Nossal Institute for Global Health at The University of Melbourne, Australia,
and a Wellcome Trust Capacity Strengthening Strategic Award to the Public
Health Foundation of India and a consortium of UK Universities. An earlier
version of this paper was presented at the Global Maternal Health
Conference, Arusha, Tanzania in January 2013.
Author details
1
Nossal Institute for Global Health, The University of Melbourne, Level 4,
Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3010, Australia.
2
Indian
Institute of Public Health Gandhina gar, Drive in Road, Thaltej, Ahmedabad,
Gujarat 380054, India.
3
Indian Institute of Management, Ahmedabad, Gujarat
380015, India.
Received: 14 February 2013 Accepted: 24 May 2013
Published: 28 May 2013
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doi:10.1186/1475-9276-12-36
Cite this article as: Saha et al.: The effect of Self-Help Groups on access
to maternal health services: evidence from rural India. International
Journal for Equity in Health 2013 12:36.
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