Integrating gender and sexuality into maternal and newborn health interventions in India

Research has shown important associations between gender and sexual equality and improved maternal health outcomes. Yet, the methods of integrating gender and sexuality into maternal health programs remain largely undocumented. From 2007 to 2009, CARE and the International Center for Research on Women implemented an operations research project in Uttar Pradesh, India to assess the added value of gender and sexuality programming on maternal and newborn health outcomes. The project utilized a quasi-experimental design. The intervention community received integrated activities to promote dialogue and behavior change around gender and sexuality in addition to a maternal health project. The control community received only the maternal health program during the operations research. Baseline and endline surveys were conducted in both communities using multi-stage sampling. Women aged 15-45 with a birth outcome in the last 6 months were eligible for the survey. Surveys measured attitudes and behaviors surrounding gender, sexuality, and maternal and newborn health. Data were analyzed using bivariate analysis and difference-in-differences modeling to assess the changes in gender, sexuality, and health indicators associated with the intervention. While indicators improved in both the control and intervention communities, the changes were greater in the intervention community. Results indicate that exposure to gender and sexuality programming is significantly associated with the ability to refuse sex, greater mobility, couple communication about family size, and delivery with a trained attendant. Integrating gender and sexuality elements into maternal health programs can contribute to improved maternal and newborn health outcomes in an Indian context.