Women's empowerment in India: assessment of women's confidence before and after training as a lay provider

Abstract

Background: Gender is the main social determinant of health in India and affects women's health outcomes even before birth. As women mature into adulthood, lack of education and empowerment increases health inequities, acting as a barrier to seeking medical care and to making medical choices. Although the process of women's empowerment is complex to measure, one indicator is confidence in ability. We sought to increase the confidence of rural Indian women in their abilities by training them as health-care providers for their community. Methods: Our partner organisation selected women through an application process requiring (1) 1 year experience as community health facilitators and (2) availability to travel and participate in a lay provider programme. Women educated to primary school level were trained by adapting an application-based curriculum previously successful in training secondary-school graduates in Haiti. We adapted the curriculum to suit the gendered context and cultivate the following skills: (1) public speaking (each woman had to teach her small group a portion of the curriculum); (2) leadership (each woman led a large group discussion on the topic); and (3) autonomy and decision making (each woman had to care for several simulated patients, making decisions about diagnosis, treatment, and transportation, and simulating a phone call to an urban doctor laying out her plan for the patient). An 11-question survey assessing confidence as care providers was administered before and after the course. Answer choices varied from “not confident” to “completely confident”. Findings: 55 women from villages in Uttar Pradesh and Bihar underwent training between August and December 2016. 54 participants completed both the pre-training and post-training surveys. Changes in mean number of responses corresponding to each confidence level are as follows: “not confident” 39·6 (SD 14·4) pre-training to 0 post-training (p<0·0001); “a little confident” 12·9 (11·8) pre-training to 0 post-training (p<0·0001); “confident” 1·5 (3·1) pre-training to 3·5 (3·9) post-training (p=0·26); “very confident” 0 pre-training to 11·5 (8·2) post-training (p<0·0001); and “completely confident” 0 pre-training to 39·2 (10·9) post-training (p<0·0001). Interpretation: Rural Indian women's confidence in their abilities as a care provider can be significantly improved by practising roles as leaders, decision-makers, and public speakers. Funding: None.