Appendix 7: Pre-analysis plan

Evaluation of Gram Varta in rural Bihar – A mixed methods study

Analysis plan

Christian Bommer1, Malavika Subramanyam2, Sebastian Vollmer1,3

October 13, 2015

1Georg-August University Göttingen

2IIT Gandhinagar

3Harvard T.H. Chan School of Public Health

Table of contents

1. Introduction ..................................................................................................................................... 3

2. Description of the Intervention ....................................................................................................... 3

3. Experimental Design ........................................................................................................................ 3

3.1. Sample selection...................................................................................................................... 4

3.2. Treatment assignment ............................................................................................................ 4

4. Data Sources .................................................................................................................................... 5

5. Hypotheses ...................................................................................................................................... 7

6. Methodology ................................................................................................................................. 10

6.1. Estimation of intention-to-treat effects ................................................................................ 11

6.2. Treatment intensity ............................................................................................................... 12

6.3. Subgroup analyses ................................................................................................................. 13

6.4. Spill-over effects .................................................................................................................... 13

6.5. Qualitative analysis................................................................................................................ 13

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1. Introduction

This pre-analysis plan outlines the main hypotheses about the short-term effects of the Gram Varta

program and specifies the methodologies to be employed in testing them. Gram Varta is a novel

health intervention currently being implemented in rural Bihar, India, building on local women’s Self

Health Groups (SHG) in order to improve health, nutrition, water, sanitation, and hygiene (HNWASH)

knowledge and practices by fostering female empowerment and community solidarity. The impact

evaluation will only deviate from the pre-analysis plan in case of unforeseen events which justify

amendments.

Section 2 of this document describes the intervention in more detail and Section 3 discusses the

study design employed for the evaluation. Section 4 then provides an overview of the different

questionnaires used to obtain the relevant information. Section 5 lists the hypotheses and Section 6

outlines the methodologies used in assessing them.

2. Description of the Intervention

Gram Varta was piloted in 2011 in Bihar and has been gradually expanded within the state since

then. It is implemented through village-based women’s self-help groups (SHG) affiliated with

Women’s Development Corporation, Jeevika and Mahila Samakhya, and relies on a participatory

learning and action (PLA) approach. The evaluation accompanies the program implementation in

Madhepura, Bihar, which was started in August 2015 and is expected to be completed in July 2016.

The core of the intervention is a cycle of 20 pre-structured meetings. A few SHG members are

selected and trained in facilitating these PLA meetings. Each facilitator invites the other SHG

members and the entire village population to participate in the meetings. The facilitator uses games,

stories and activities to bring the women together, enhance women’s sense of agency, and change

their attitude towards working together, service utilization as well as indirectly impact their HNWASH

knowledge and practices. Participants are encouraged to think critically, identify problems in their

households and communities and discuss how HNWASH practices could be improved. Pregnant

women, adolescent girls and children under the age of five are of special interest. This process

includes at least two meetings with the entire community including local authorities and service

providers. The identified problems and solutions are discussed and a community action plan is

formulated. Monitoring progress towards meeting pre-set goals is also a part of Gram Varta.

3. Experimental Design

The impact evaluation of the Gram Varta Program combines a randomized design with a difference-

in-differences approach in order to identify causal effects on maternal and child health, HNWASH

indicators, demand for services as well as female empowerment. It will incorporate both qualitative

and quantitative information, facilitating the understanding of possible channels of change which will

help to explain the presence or absence of certain effects. The following two subsections provide a

short outline of the sampling strategy and the treatment assignment.

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3.1. Sample selection

As mentioned above, the evaluation of Gram Varta analyzes the program effects in Madhepura. The

district is divided into thirteen blocks comprising a total of 443 gram panchayats. However, given

that Gram Varta is implemented in only six of these thirteen blocks and due to budgetary constraints,

we restricted the sample to 68 gram panchayats, each of which contained about 2.6 villages on

average. This left us with a total of 180 villages. When the enumerators reached the villages, they

talked to local residents as well as the gram panchayat head (Mukhiya) and roughly mapped out the

different hamlets (tolas) in the village which were based on caste in most cases. They also inquired

the number of households in each hamlet. We planned to sample 22 households per village. Based

on the total households in the entire village and the number of households in the different hamlets,

enumerators arrived at the number of households in each hamlet they needed to interview given our

sample size calculations. The number of houses per hamlet was proportional to the total number of

houses each hamlet contained in comparison with the total number of households in the entire

village (probability proportional to size of hamlet).

Once the enumerators calculated how many houses they needed to sample in each hamlet (n), and

the total number of houses in that hamlet (N), they randomly picked the first house (ninth household

from the public facility in the hamlet) and then chose every ninth house. Once they reached the

house, they selected the head of the household for the "main" survey. If the head was not available,

they talked to the adults available at home and picked one adult who seemed to have the

information about the household. After getting information from the head of the household, they

interviewed a woman in the household who is in the 15-49 age group and had the youngest child in

the household, compared to all other women in a similar age group in the household. If no such

woman was available, they interviewed the woman with the next older child and so on. Questions to

adolescent girls (all available adolescent girls in the family) and measurement of height, weight,

hemoglobin as well as stool tests were performed by the female enumerator who visited the same

house the next day. Moreover, pregnant women were oversampled, given that the share of this

group would have been too low in the household sample to achieve sufficient statistical power.

Listing of women who are currently pregnant was done using information obtained from Anganwadi

workers.

3.2. Treatment assignment

To be able to estimate causal effects, we randomly assigned Gram Varta participation. The

randomization process took place on the gram panchayat level and, in order to maximize precision,

we stratified by block. To this end, we first listed all gram panchayat in our study area together with

the block they belonged to. Afterwards, we randomly assigned participation in Gram Varta to gram

panchayats separately by block with a probability of 50%. An alternative strategy involving pair-wise

matching of blocks and treatment assignment on the block level was rejected as census data

revealed a substantial heterogeneity between blocks. Our randomization approach left us with 34

gram panchayats, 90 villages and 1,973 households in the treatment group, while the control group

comprises 34 gram panchayats, 90 villages and 1,980 households. Moreover, the pregnant women

sample contains 1,234 subjects in the treatment group and 766 subjects in the control group.

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4. Data Sources

We plan to collect data thrice:

Baseline survey prior to Gram Varta implementation.

Small midline survey while the Gram Varta meeting cycle is still ongoing.

End-line after Gram Varta ends.

The differences in changes from baseline to end-line between treatment and control will show us the

causal effects of Gram Varta, while the midline survey will facilitate the monitoring of process

indicators. Given our mixed-method approach, the survey comprises both quantitative and

qualitative elements. For the quantitative part, trained enumerators from the local area will conduct

household and individual interviews guided by pre-coded paper questionnaires developed to

measure process, outcome and impact indicators. Specifically, the following modules will be

administered:

1. Household questionnaire, 1st part (respondent is any adult household member):

For each sampled household a roster to record demographic information and health indicators of

all household members.

2. Household questionnaire, 2nd part (respondents are women and adolescent girls in the

household): This questionnaire will be concerned with women, adolescent girls and child health

and nutrition indicators. We will collect blood and stool samples and anthropometric data from

children.

3. Household questionnaire, 3rd part (respondent is a woman in the household):

This part will contain sections on outcomes (e.g. general HNWASH practices in the household,

related attitudes, beliefs and knowledge, perceived social norms, HNWASH related consumption

behavior) and enabling context (e.g. economic situation of household). Gram Varta participation

and potential obstacles to participation (only treatment group) as well as indicators related to

mediators such as speaking up in groups, a sense of empowerment, critical-thinking, feeling of

community cohesion or even tension, trust in service providers.

4. Pregnant women questionnaire:

A questionnaire for pregnant women will collect data on knowledge, beliefs, social norms and

practices relevant to pregnancy, child birth, and the post-natal period. We will collect blood

samples from these women. In the follow-up we will collect data on the women who were

pregnant at baseline and their newborns as well as newly pregnant women.

5. Facilitator questionnaire:

We will collect data from Gram Varta facilitators on participation of all target groups in meetings

(pregnant women, adolescent girls, marginalized women) and other process indicators (meetings

were implemented as scheduled, any complications, whether frontline workers, men and elderly

participated, which problems were identified and prioritized on the village level, details on the

community action plan, etc.).

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6. Anganwadi worker questionnaire:

We will collect data from the Anganwadi worker on indicators of service use.

To provide an idea of the impact of Gram Varta in Madhepura as well as other districts of Bihar,

survey information will be further complemented by an analysis of secondary data. We will use

available data from Gram Varta MIS, other sources such as the census, AHS, the concurrent

monitoring survey being conducted by B TAST, and other surveys; routine data collected at

Anganwadi centers; as well as relevant observations from enumerators such as evidence of open

defecation in the village, availability of soaps in households, and method of drinking water storage.

These data will be analyzed quantitatively to investigate differences between treatment and

counterfactual areas, using appropriate statistical techniques for quasi-experimental studies.

For the qualitative part of the analysis we will be guided by the qualitative expert, Dr. Rosa Perez,

and women’s empowerment expert, Dr. Manisha Joshi, and plan to employ researchers experienced

in the use of qualitative inquiry in the Indian context. The underlying goal will continue to be to

inquire what the impact of Gram Varta is and how exactly this impact occurs. However, the

qualitative approach will focus on understanding it in a deeper manner, giving more importance to

understanding what the experience of Gram Varta participation means (to participants/facilitators/

community members/front-line workers), and the various ways it may have affected the lives of

participants as well as community members. The process of change will be of special focus. The

choice of methods will depend on what is appropriate in a given context, but will include participant

observation, key informant interviews, focus groups, in-depth interviews, participatory games, and

others.

Table 1: Timeline (Tentative, depends on actual implementation schedule) Questionnaire Baseline Midline Endline

Household – 1 3/2015 – 4/2015 6/2016 – 7/2016 Household – 2 3/2015 – 4/2015 6/2016 – 7/2016 Household – 3 3/2015 – 4/2015 10/2015 – 11/2015 6/2016 – 7/2016 Pregnant woman 3/2015 – 4/2015 6/2016 – 7/2016 Facilitator 10/2015 – 11/2015 6/2016 – 7/2016 Anganwadi worker 8/2015 – 9/2015* 6/2016 – 7/2016 Qualitative data 7/2015 11/2015 and 2/2016 6/2015

* The Anganwadi worker baseline survey was collected later than the other quantitative baseline surveys due to unforeseen delays in the field. However, only few SHG meetings were already conducted until September 2015, so that the bias arising from this delay should not be large.

The data collection process is summarized in Table 1. The first and second part of the household

questionnaire, the pregnant women questionnaire and the Anganwadi worker questionnaire will

only be used to gather information at baseline and endline. In contrast, part three of the household

questionnaire and the qualitative study component will be applied at baseline, midline and endline.

Finally, questions about facilitating Gram Varta meetings will only be asked at midline and endline,

given that it would have been too early at baseline to already assess meetings and program uptake

by different stakeholders.

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5. Hypotheses

Group 1: Women’s self-help groups

Women’s self-help groups (SHG) are at the center of the Gram Varta program. One part of our

analysis will therefore focus on the processes happening within SHG groups and look at the

interaction of SHG members with the community. To this end, we will use indicators acquired from

the facilitator surveys at midline and endline. Specifically, we will test the following eight hypotheses:

H1: Gram Varta improves participation in SHG meetings.

H2: Gram Varta increases SHG acceptance in and cooperation with community.

H3: Gram Varta improves provision of information on health practices within SHG.

H4: Gram Varta improves provision of health finance information and practices within SHG.

H5: Gram Varta improves awareness and usage of government health services by SHG members.

H6: Gram Varta improves frequency of promoting enrolment to VO nutrition center

H7: Gram Varta improves awareness and usage of VO nutrition centers by SHG members.

H8: Gram Varta improves facilitators' health knowledge.

H9: Gram Varta improves facilitators' opinion on their work.

Group 2: Women's agency and empowerment

Next, we will look at Gram Varta's effect on women's agency and empowerment. The ways in which

the program may impact women's standing in the family and community are manifold. First, we

anticipate that the participatory learning approach will encourage self-help group members to think

more critically and to question societal standards as well as make them more comfortable at voicing

their opinion in public. Second, adolescent girls will indirectly benefit from their mothers'

involvement and develop a stronger self-esteem and a more positive outlook on their future. Lastly,

we expect that the involvement of men in some SHG sessions will also increase the willingness of

husbands to support their wives and to rethink cultural standards. The indicators which will be used

to test the following hypotheses are taken from the household surveys and pregnant women

surveys.

H10: Gram Varta encourages women to acquire paid work and to become economically more

independent.

H11: Gram Varta increases women's bargaining power within the household.

H12: Gram Varta enables women to become more independent of their husbands.

H13: Gram Varta enables women to develop an identity of their own.

H14: Gram Varta increases women's involvement in the community.

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H15: Gram Varta makes women become more comfortable at speaking out in public.

H16: Gram Varta makes self-confident when it comes to refusing sexual intercourse with husband or

demanding him to use a condom.

H17: Gram Varta reduces women's acceptance of domestic violence.

H18: Gram Varta reduces the practice of domestic violence and oppression.

H19: Gram Varta gives adolescent girls a more positive outlook on their future.

H20: Gram Varta reduces adolescent girls' preferred number of children.

H21: Gram Varta decreases women's preference for sons.

H22: Gram Varta makes it more likely that women desire a higher age at marriage for themselves or

their daughters.

H23: Gram Varta reduces the likelihood of early pregnancies.

H24: Gram Varta improves attitudes towards and practices of care for daughters.

H25: Gram Varta makes adolescent girls more confident to cook for themselves in order to take care

of their own nutrition.

H26: Gram Varta increases husbands' support for their wives' SHG membership.

Group 3: HNWASH knowledge and practices

The key element of Gram Varta is the uptake of health knowledge among SHG members through the

use of participatory learning methods. In order to evaluate the program's success, it is hence crucial

to look at the development of HNWASH knowledge and practices in SHG and the community. We

expect households and pregnant women in treatment areas to exhibit a better understanding of

basic issues in health, hygiene and nutrition as well as to implement their knowledge through the use

of proper practices. The indicators we will use to test our hypotheses in this section will be taken

from the household and pregnant women surveys.

H27: Gram Varta increases the intake of micronutrients.

H28: Gram Varta raises awareness of importance of balanced diet for family.

H29: Gram Varta improves knowledge and attitudes toward proper feeding of newborns.

H30: Gram Varta encourages parents to prevent diseases in children, e.g. through vaccinations and

bednets.

H31: Gram Varta reduces risky consumption behavior (tobacco/alcohol).

H32: Gram Varta improves domestic storage and treatment of water.

H33: Gram Varta improves domestic hygiene (hand-washing/use of toilets).

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H34: Gram Varta increases women's awareness about infectious diseases such as malaria.

H35: Gram Varta improves adolescent girls' and women's knowledge about sexuality and

contraception.

Group 4: Pregnancy

An important group of beneficiaries of Gram Varta are pregnant women, given that their health

knowledge and practices do not only affect themselves but also the health of their unborn children.

This group of hypotheses will therefore in particular look at pregnant women's behavior during

pregnancy as well as antenatal care.

H36: Gram Varta encourages pregnant women to be mindful of their health, to take healthy and

sufficient diet, to avoid stress and to avoid health risks.

H37: Gram Varta increases the frequency of antenatal care visits as well as their quality.

H38: Gram Varta increases support to pregnant women for obtaining antenatal care.

H39: Gram Varta increases pregnant women's satisfaction with antenatal care.

H40: Gram Varta encourages women to accept their pregnancy, making them more optimistic about

their situation.

H41: Gram Varta raises awareness and understanding of abortions among pregnant women.

Group 5: Anganwadi centers

An important part of the intervention is the participation of local service providers in selected SHG

meetings. We expect that these meetings will improve the health knowledge of Anganwadi workers

and increase the quality of offered services. To assess the following hypotheses, we will make mainly

use of data collected directly from local Anganwadi workers.

H42: Gram Varta increases use of Anganwadi health centers.

H43: Gram Varta improves malnutrition treatment and prevention.

H44: Gram Varta improves the quality of child weighing practices.

H45: Gram Varta improves the cleanliness of and hygiene practices at the Anganwadi center.

H46: Gram Varta improves quality of work and activities related to preschool children.

H47: Gram Varta improves counseling for pregnant and lactating women.

H48: Gram Varta improves postnatal care.

H49: Gram Varta improves Anganwadi workers' health knowledge.

H50: Gram Varta improves immunization practices.

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H51: Gram Varta improves facilitation of routine check-ups.

H52: Gram Varta increases job satisfaction of Anganwadi workers.

H53: Gram Varta improves participation of Anganwadi workers in community health events.

H54: Gram Varta improves perception of and respect for Anganwadi workers by community.

Group 6: Health outcomes

Provided that Gram Varta is successful in improving health knowledge and services as well as in

altering health-related behavior, we expect to see some mild improvements in the health status of

women, men and children at endline. For instance, improved iron intake due to nutritional training is

expected to improve hemoglobin levels in subjects, provided that they are anemic. To assess

whether this is true, we will use a mix of verbal autopsy data and anthropometric measures from the

household and pregnant women surveys.

H55: Gram Varta improves women's health.

H56: Gram Varta improves husbands' health.

H57: Gram Varta improves child health.

Group 7: Social cohesion

Lastly, we expect Gram Varta to strengthen the general social relationships within the community. To

test our related hypotheses, we will make use of indicators collected in the household surveys.

H58: Gram Varta increase mutual trust within the community.

H59: Gram Varta reduces tensions in the neighbourhood.

A detailed overview of all hypotheses and indicators is given in Appendix Table A1. For each

indicator, we provide the data source, the format of the data and the anticipated direction of the

effect.

6. Methodology

The estimation methods we plan to use depend on the format of the indicators which form the basis

for the hypotheses tests. Integer and real variables will be analyzed using ordinary least squares.

However, the majority of indicators is based on binary data and requires the use of more

sophisticated methods, as linear probability models are inefficient and may lead to unrealistic

predictions. We therefore plan to model the probability that a binary indicator equals one as a

logistic function which will guarantee predictions within the [0,1] interval. Moreover, in some cases,

indicators are coded on an ordinal scale, requiring the use ordered logit models since linear models

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would implicitly assume that the data are defined on a cardinal rather than ordinal scale. Standard

errors will be clustered on the ID-level (i.e. household head, pregnant woman, Anganwadi worker

etc., depending on the context) in order to account for serial correlation and heteroscedasticity, and

on the village-level to reflect the multi-level sampling design.1,2

Given that not all self-help group members necessarily attend and participate in every meeting,

comparing treated and not treated gram panchayats will provide an estimate for the effect of the

intention to treat rather than the treatment itself. In other words, we would not measure the effect

of participatory learning in self-help groups, but rather the effect of offering it. Since voluntary

participation is a key element of these groups, we believe that the intention-to-treat effect will be

more interesting to policy makers than the treatment effect on the treated and the main emphasis of

our analysis will hence be on the effect of program assignment. Nevertheless, it will be useful to take

a closer look at the extent to which the treatment effects vary depending on the number of meetings

SHG group members have attended, as this will provide us with information on the effect of

treatment intensity and allow us to assess whether there are decreasing marginal returns to holding

additional meetings. Additionally, we plan to investigate spill-over effects of Gram Varta membership

on non-participating households in treatment areas and heterogeneous intention-to-treat effects

depending on a range of individual and household characteristics, such as caste, age and poverty.

By virtue of random assignment of the intervention, a simple comparison of post-intervention

outcomes between treated and non-treated gram panchayats will on average provide us with the

correct intention-to-treat effect. Nevertheless, it is possible that imbalances between the treatment

and control group in our experiment regarding observable or unobservable characteristics occur by

chance, leading to selection bias. We will thus exploit the panel-structure of our study and employ a

difference-in-differences approach in order to control for baseline differences and a common time

trend. In order to further reduce potential bias, we also control for a range of observable individual

and household characteristics, such as socioeconomic status. This will also have the side effect of

increasing the precision of our estimate even if our controls are uncorrelated to treatment

assignment but correlated to the outcome since the share of unexplained variation in the outcome

will decline. The following subsections provide a description of the main elements of our analysis.

6.1. Estimation of intention-to-treat effects

The main analysis of our evaluation will test the hypotheses outlined in Section 5 by an intention-to-

treat analysis. As illustrated in Table 1, some surveys are collected at baseline, midline and endline,

while other surveys are either only collected at baseline and endline or at midline and endline. In

case the data is collected thrice and assuming that the outcome variable is cardinal, the analysis will

have the following form:

𝑌𝑖𝑔𝑡 = 𝛾𝑖 + 𝜆𝑡 + 𝛽1𝐷𝑔1 + 𝛽2𝐷𝑔2 + 𝑋𝑖𝑔𝑡𝛿 + 휀𝑖𝑔𝑡 (1)

1 While efficiency gains might be realized by using a random effects (RE) model instead, the underlying assumptions about RE are very restrictive and unlikely to be fulfilled in the setting of our study. 2 As the number of hypotheses we intend to test is high, we will investigate the robustness of our inference by applying the Benjamini-Hochberg correction for multiple hypotheses tests.

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where 𝑌𝑖𝑔𝑡 is the outcome for unit i (e.g. pregnant woman/household head/Anganwadi) in gram

panchayat g at time t, with 𝑡 = 0 at baseline, 𝑡 = 1 at midline and 𝑡 = 2 at endline. 𝛾𝑖 and 𝜆𝑡 are

unit-level and time fixed effects, respectively, where 𝜆0 = 0. 𝐷𝑔1 and 𝐷𝑔2 are dummy variables that

equal 1 if the data comes from midline or endline, respectively, and gram panchayat g was assigned

to the treatment group. The corresponding coefficients 𝛽1 and 𝛽2 will therefore estimate the

intention-to-treat effects at midline and endline, taking the outcomes at baseline as reference

values. Moreover, 𝛿 is a vector of coefficients, capturing the contribution of a range of control

variables.

If only two time periods are available, equation 1 simplifies to:

𝑌𝑖𝑔𝑡 = 𝛾𝑖 + 𝜆𝑡 + 𝛽1𝐷𝑔1 + 𝑋𝑖𝑔𝑡𝛿 + 휀𝑖𝑔𝑡 (2)

with 𝑡 = 0 at baseline or midline, depending on when the first survey is conducted, and 𝑡 = 1 at

endline. The treatment effect at endline will now be given by 𝛽1 rather than 𝛽2, but the underlying

concept remains identical. Note, that in case of binary or ordinal outcomes, 𝑌𝑖𝑔𝑡 in the above

equations does not denote the outcome itself but rather the propensity of unit i to achieve a certain

outcome. While the logic of the difference-in-differences approach still applies, the consequence of

this more complicated setup is that 𝛽1 and 𝛽2 are not interpretable as marginal effects on the

probability of a certain outcome, as we model this probability as a logistic (i.e. non-linear) function of

the right-hand side variables. Therefore, we plan to express effect sizes as odds ratios, which are

simply the antilog of the respective coefficients and a widely applied metric in health economics.

To put the estimated effect sizes into perspective, we plan to conduct a cost-benefit analysis. For

health indicators there is a standard procedure which we will follow. We will express effects on all

health indicators in terms of Disability-adjusted life years (DALYs) averted. DALYs are a metric that is

officially adopted by the World Health Organization and constructed by a group of researchers

including the Institute for Health Metrics and Evaluation at the University of Washington and the

Harvard T.H. Chan School of Public Health. DALYs are a tool to quantitatively compare the burden

from different diseases. After converting the effects of Gram Varta into DALYs averted for all

indicators, we will sum up the total number of DALYs averted through Gram Varta. These will then be

compared to the program's costs, allowing us to obtain the number of DALYs prevented per $1.

Moreover, Gram Varta also aims at improving non-health indicators such as female empowerment.

Here we will express the improvement in the indicators in terms of $1 invested in Gram Varta. These

effects would be in addition to the health effects of Gram Varta. There is no standard metric for

quantitatively comparing DALYs with non-health indicators, thus we will present these indicators side

by side.

6.2. Treatment intensity

The fact that participation in SHG meetings is voluntary makes it likely that there will be differences

in the treatment intensity for different women. We plan to exploit this design feature in order to

estimate the marginal effect of an additional SHG meeting. The analysis will focus on data acquired

from the household surveys and the pregnant women surveys as we do not expect much variation in

the treatment intensity for Anganwadi workers. We plan to use an approach similar to those outlined

in equation 1 and 2 with the difference that 𝐷𝑔1 and 𝐷𝑔2 are now not simple dummies but rather

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integer variables counting the number of times a women from a treated gram panchayat has

participated in SHG meetings in case the outcome is measured at endline.

6.3. Subgroup analyses

We plan to augment our study by estimating separate intention-to-treat effects by subgroups. To this

end, we will stratify our sample by caste, age and poverty and run separate regressions of the types

depicted in equation 1 and 2. We expect that intention-to-treat effects on HNWASH knowledge and

practices as well as health outcomes and female empowerment will be smaller for scheduled castes

and the poor, as SHG meetings may not be completely inclusive for members of these groups who

may consequently not feel a strong sense of ownership of the program.

In addition, we will analyze, whether the intention-to-treat effects vary with the length of time the

SHGs have been operational (this may just be applicable in non-Jeevika areas, since Jeevika employs

a model where SHG activities are initiated only when the SHG attains a certain level of maturity in

functioning, but there might still be differences in the length of time since the SHGs were

operational). Gram Varta relies on the functionality of SHGs and might be less influential if a SHG is

not already well established. Moreover, we plan to stratify on infrastructural indicators, as some of

Gram Varta's possible behavioral effects will potentially depend on infrastructural prerequisites. For

instance, we will try to answer questions like `Do individuals not use toilets because they are not

aware that open defecation is harmful for good health in their community or is the necessary

infrastructure just lacking?´

6.4. Spill-over effects

A further aim of the study will be to measure spill-over effects of Gram Varta on non-participating

households in the same gram panchayat. We expect that the non-SHG members in treatment

communities will self-select into participating in Gram Varta meetings. We will not be able to obtain

credible information from non-SHG-individuals in the counterfactual communities on their potential

for self-selection into participation (had they gotten an opportunity to do so). Therefore, a simple

comparison of the non-SHG-individuals in the counterfactual communities with the non-participants

in the treatment communities might suffer from selection bias. To deal with this, we will draw

random samples of non-SHG-households in the counterfactual and treatment communities

independent of their participation status. We will then match the treatment group in non-

participating households with comparable households in the counterfactual group using propensity

scores. The propensity score will be based on a wide range of socio-economic characteristics with a

special focus on indicators which are hypothesized to determine self-selection into participation such

as sense of empowerment, child care obligations, distance to venue, economic situation, etc.

6.5. Qualitative analysis

In addition to the quantitative part of the evaluation, we will make use of qualitative information in

order to understand what experiencing Gram Varta means to participants. This will allow us to better

understand the process of change, enable us to draw conclusions about the causal pathways driving

our results and enhance our ability to assess the external validity of our results. As mentioned above,

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we will make use of a broad range of methods, including participant observation, key informant

interviews, focus groups, in-depth interviews as well as participatory games.

The qualitative component of the study will be leveraged to provide insights into the transferability

of findings by delving deeper into the context of program implementation and asking questions such

as: how much of the program is driven by the particular personalities involved and how much of it is

due to the design of the program itself; what aspects of context matter when it comes to

acceptability and sustained interest in program participation; how do the experiences of participants

and facilitators in other districts differ from those in Madhepura district; and, which aspects of the

entire program are reported as important/helpful by facilitators and participants in Madhepura

versus other districts.

Appendix

This tables list the indicators that will be used to test the above hypotheses. We also provide the

code of the question an indicator is based on, the expected direction of the effect, the code for the

respondent (see legend) and the format of the data that will used to evaluate progress made on an

indicator.

Table A: List of hypotheses and indicators

Group Hypo, Indicator Question code Dir. Resp. Format

Group 1 H1 Frequency of SHG meetings RM01 + F ordinal

Meetings took place as scheduled RM02 + F binary

Complications: People did not respect facilitator RM06 - F binary*

Complications: Few people coming to meetings RM06 - F binary*

Complications: Unable to agree on future meetings RM06 - F binary*

Complications: Peope did not listen RM06 - F binary*

Number of people attending meetings MT01 + F integer

Number of elderly attending meetings MT02 + F integer

Number of lactating women attending meetings MT03 + F integer

Number of adolescent girls attending meetings MT04 + F integer

Number of men attending meetings MT05 + F integer

Date and time of meetings proposed by group members MT23 + F binary*

Peope approach facilitator to access services RW03 + F binary

Active participation of SHG members in meetings MT24 + F ordinal

H2 Challenges to SHG members: Participation not approved by husband or community MT27 - F binary*

Challenges to SHG members: Not taken seriously by community when proposing actions MT27 - F binary*

SHG currently involved in community action on health MT07 + F binary*

Cooperation between village and SHG members when solving problems MT25 + F ordinal

Believes that people listen to her advice RW08 + F ordinal

Bad experience when working with community RW10 - F binary

Believes that cooperation with community makes sense RW12 + F binary

Decision makers in the village like ASHA, ANM, Sarpanch, Gram Sevak seek her opinion RW13 + F binary

People listen to her and seek her opinion during Gram Sabha meetings RW14 + F binary

H3 SHG currently involved in health messaging programs MT07 + F binary*

Frequency of discussing proper water and sanitation methods in meetings MT13 + F ordinal

Promotes appropriate methods to make drinking water safe MT14 + F binary*

Training SHG members on proper sanitation and water usage is necessary MT15 + F binary

Frequency of discussing neonatal and infant care practicies MT16 + F ordinal

Frequency of disussing vaccination during pregnancy and early childhood MT17 + F ordinal

Talked to any SHG member about nutrition of mothers/children and child care MT18 + F binary*

Frequency of discussing breastfeeding practices MT19 + F ordinal

Frequency of discussing nutrition related topics MT20 + F ordinal

Frequency of discussing contraception MT21 + F ordinal

H4 SHG currently involved in micro credits MT07 + F binary*

SHG currently involved in health risk funds MT07 + F binary*

Discussed health risk fund during meetings MT11 + F binary

Frequency of discussing health savings MT12 + F ordinal

Number of SHG members keeping aside money as health savings HR01 + F integer

16

Discussed health risk fund with SHG members during training HR02 + F binary

Number of people in community currently enrolled HR03 + F integer

Number of deposits made last month HR04 + F integer

H5 Informs SHG households about benefits from government health facilities PH01 + F binary

Number of SHG women using government health facilities in last months PH02 + F integer

Discusses problems faced by SHG households when using health facilities PH15 + F binary

H6 Frequency of promoting enrolment to VO nutrition center VO02 + F ordinal

H7 Number of SHG members succesfully enrolled to VO nutrition center in last 2 months VO03 + F integer

Number of women enrolled in VO nutrition center in total at the moment VO04 + F integer

Amount of time spend in VO centers per week by facilitator VO05 + F real

Number of training programs conducted at VO centers per months VO06 + F integer

Number of women participating in training programs VO07 + F integer

Number of households the facilitator provided counseling to during last month VO09 + F integer

H8 Believes that hands need to be washed frequently KA01 + F binary

Believes that soap should be used when washing hands KA01 + F binary*

Using soap after toilet is important KA02 + F binary*

Using soap before eating is important KA02 + F binary*

Using soap before cooking is important KA02 + F binary*

Using soap before feeding children is important KA02 + F binary*

Using soap before going to bed is important KA02 + F binary*

Knows required frequency of ANC KA03 + F binary*

Believes women should take IFA tablets during pregnancy KA04 + F binary

Importance of tetanus injection before giving birth KA05 + F ordinal

Important that pregnant women get enough food KA06 + F binary*

Important that pregnant women get balanced diet KA06 + F binary*

Knows health effects of polio vaccine KA07 + F binary*

Knows health effects of MMR vaccine KA07 + F binary*

Importance of feeding thick yellowish breast milk KA08 + F ordinal

Breastfeeding instead of giving water to drink can protect babies from diseases KA09 + F ordinal

Timing of starting to giving bottled water to a child KA10 + F ordinal

Knows most important methods of family planning KA11 + F binary*

Condoms are effective in preventing STDs like HIV/Aids KA13 + F binary

Wife justified in asking husband to use condom if he has STD KA14 + F binary

Open defecation and open sewage water are health hazards KA15 + F binary

Importance of using toilet KA16 + F ordinal

Importance of covering excreta with mud when no toilet exists KA16 + F ordinal

Importance of ensuring that women get a good balance of food KA17 + F ordinal

Importance of ensuring that adolescent girls get a good balance of food KA18 + F ordinal

Importance of ensuring that adolescent girls get enough food and attention KA19 + F ordinal

Amount of food women should be given during period KA20 + F ordinal

Importance of IFA tablets for adolescent girls KA21 + F ordinal

Importance of ensuring that children get good balance of food KA22 + F ordinal

Good balance of food protects families from disease and malnutrition KA23 + F binary

Importance of starting complementary feeding after age of six months KA24 + F ordinal

Importance of adding oil to meals for children aged 6 to 59 months KA25 + F ordinal

Importance of cutting children's hair short KA26 + F ordinal

Knows appropriate ways to make water safe to drink KA27 + F binary*

17

Knows danger signs of malaria KA28 + F binary*

Knows danger signs of acute respiratory infection KA29 + F binary*

Knows what to do when child suffers from diarrhea KA30 + F binary*

Knows danger signs of dehydration caused by diarrhea KA31 + F binary*

Holding babies in contact with mother's warm skin is good practice KA32 + F binary

Knows information on DIDI sheet KA33 + F ordinal

Knows 5 Panchsutras KA34 + F binary

H9 Satisfied with work as community mobilizer RW01 + F binary

Feels respected by SHG members and community RW05 + F binary

Feels that her work is appreciated by SHG members RW06 + F binary

Believes that SHG members are happy with her services RW07 + F binary

Group 2 H10 Women earns any income JB02a, JB03a + H binary

Woman has any savings SV02 + H binary

Level of women's savings SV04 + H real

Hours spent on unpaid household work in last seven days AG03 - AG integer

Woman has ever taken loan to start business FE03 + FH binary

Husband does/did not trust woman with money HR05 - FH binary

H11 Woman has say in use of income JB02e, JB03e + H binary

Woman can decide on her own how savings are spent SV06, SV07 + H binary

Participates in health care decisions FE01 + FH binary*

Participates in major household purchase decisions FE01 + FH binary*

Participates in decisions on visits to family and relatives FE01 + FH binary*

Participates in major farm decisions FE01 + FH binary*

Participates in decisions on use of own earnings FE01 + FH binary*

Woman participates in decisions on use of husbands earnings FE01 + FH binary*

Woman participates in decisions on land/house purchase and use FE01 + FH binary*

Makes decision about health care alone or jointly with husband WE3 + PW binary*

Makes decision about major household purchases alone or jointly with husband WE3 + PW binary*

Makes decision about visits to family alone or jointly with husband WE3 + PW binary*

Makes decision about farm matters alone or jointly with husband WE3 + PW binary*

Makes decision about number and timing of children alone or jointly with husband WE4 + PW binary*

H12 Allowed to go to market alone FE05 + FH binary

Allowed to go to health facility alone FE05 + FH binary

Allowed to go to neighbour's home alone FE05 + FH binary

Allowed to go to friends/relatives outside the village alone FE05 + FH binary

Allowed to go to places of worship alone FE05 + FH binary

Allowed to go to market alone FE05 + FH binary

Feels recognized in community as herself rather than mother/wife WE1 + PW binary*

Allowed to go alone to market WE2 + PW binary

Allowed to go alone to health facility WE2 + PW binary

Allowed to go alone to neighbor's home WE2 + PW binary

Allowed to go alone to friends/relatives outside the village WE2 + PW binary

Allowed to go alone to place of worship WE2 + PW binary

H13 Mostly known as husband's wife in village FE04 - FH binary*

H14 Acquainted with health staff SC01 + FH binary

Acquainted with government officials SC01 + FH binary

Acquainted with school officials SC01 + FH binary

18

Acquainted with official from village panchayat / nagarpalika / ward committee SC01 + FH binary

Not allowed to participate in community activities SC03 - FH binary

Not allowed to participate in community activities because of gender SC04 - FH binary*

Voted in most recent national election SC05 + FH binary

Attended public meeting of village Panchayat / Nagarpalika / ward committee last year SC06 + FH binary

H15 How often states own opinion in public FE06 + FH ordinal

H16 Wife can refuse intercourse if husband has STD RH23 + FH binary*

Wife can refuse intercourse if husband has sex with other women RH23 + FH binary*

Wife can refuse intercourse if she is tired/not in mood RH23 + FH binary*

Wife can demand husband to use condom if he has STD RH24 + FH binary

Women can decide on her own about family planning KA12 + F binary*

H17 Husband justified in hitting wife if she goes out without telling him HR04 - FH binary

… if she neglects children HR04 - FH binary

… if she argues with him HR04 - FH binary

… if she refuses to have sex with him HR04 - FH binary

… if she burns the food HR04 - FH binary

Believes husband is justified in beating wife is she goes out without telling him AG12 - AG binary

Believes husband is justified in beating wife is she neglects children AG12 - AG binary

Believes husband is justified in beating wife is she argues with him AG12 - AG binary

Believes husband is justified in beating wife is she refuses to have sex with him AG12 - AG binary

Believes husband is justified in beating wife is she burns the food AG12 - AG binary

H18 Afraid of husband HR03 - FH ordinal

Husband jealous or angry if woman talks/talked to other men HR05 - FH binary

Husband frequently accuses/accused woman of being unfaithful HR05 - FH binary

Husband does/did not allow woman to meet her female friends HR05 - FH binary

Husband tries/tried to limit woman's contact with her family HR05 - FH binary

Husband insists/insisted on knowing where woman is HR05 - FH binary

Husband pushed/shaked woman or threw something at her in last 12 months HR06 - FH binary

Number of times pushed/shaked or being thrown at by husband in last 12 months HR06 - FH integer

Husband kicked/dragged/beat up woman in last 12 months HR06 - FH binary

Number of times kicked/dragged/beaten up by husband in last 12 months HR06 - FH integer

Husband tried to choke woman or burn her on purpose in last 12 months HR06 - FH binary

Number of times choked or burned on purpose by husband in last 12 months HR06 - FH integer

Husband forced women to perform non-consensual sexual activity in last 12 months HR06 - FH binary

Number of times forced to perform non-consensual sexual activity in last 12 months HR06 - FH integer

Pushed/shaked/having things thrown at by husband during pregnancy WE8 - PW binary

How often? WE8 - PW integer

Kicked/dragged/beaten up by husband during pregnancy WE8 - PW binary

How often? WE8 - PW integer

Choked/burned on purpose by husband during pregnancy WE8 - PW binary

How often? WE8 - PW integer

Forced to do perform non-consensual sexuality activites by husband during pregnancy WE8 - PW binary

How often? WE8 - PW integer

H19 Lack of self-confidence is obstacle for future AG07 - AG ordinal

Lack of family support is obstacle for future AG07 - AG ordinal

Marriage is obstacle for future AG07 - AG ordinal

Domestic responsibility is obstacle for future AG07 - AG ordinal

19

Mobility is obstacle for future AG07 - AG ordinal

Believes husband should make all important decisions AG13 - AG binary

Expected asset ownership compared to parents (less, equal, more) AG08 + AG ordinal

Expects to become housewife AG05 - AG binary

Expected satisfaction with future occupation AG06 + AG ordinal

Wants to copy parents' model of men's and women's role AG13 - AG binary

H20 Desired number of children AM15 - AG integer

H21 Preference for boy AM18 - AG binary

Pregnant woman preference for boy RH15 - PW binary

H22 Youngest age at which (hypothetical) daughter should get married FE08 + FH integer

Youngest age at which (hypothetical) daughter should have first child FE08 + FH integer

Ideal age of marriage for girls AM02 + AG integer

Difference between ideal age of marriage for girls and for boys AM02 - AG integer*

Believes that women marry to young in India AM13 + AG binary

Feels pressured to get married AM13 - AG binary

Preferred age at marriage AM11 + AG integer

H23 Is pregnant AM14 - AG binary

H24 Opinion of HH head on ensuring that daughters get enough food and attention CD01 + H ordinal

Peope I respect agree that daughter should get enough food and attention CD02 + H ordinal

Opinions of respected persons with respect to care of daughter matter to me CD03 - H ordinal

I want to behave similar other people like me regarding care of daughters CD05 - H ordinal

Confident that I can ensure my daughters get enough food and attention CD06 + H ordinal

Determined to ensure my daughters get enough food and attention CD08 + H ordinal

Enough food and attention for daughter is protective against disease and malnutrition CD10 + H ordinal

Ever felt like not getting enough food AN01 - AG ordinal

Usually ends up eating last AN02 - AG ordinal

Is given less food than usual when having period AN04 - AG ordinal

Number of full meal per day eaten AN05 + AG integer

Thinks that girls and boys should have same access to education FE07 + FH binary

Ease of talking to mother about problems AG10 + AG ordinal

Feels that parents pay enough attention to her AG11 + AG binary

Opinion on ensuring that daughters get enough food and attention NT17 + PW ordinal

Peope I respect agree that daughter should get enough food and attention NT18 + PW ordinal

Opinions of respected persons with respect to care of daughters matter to me NT19 - PW ordinal

Most people I respect ensure that daughters get enough food and attention NT20 + PW ordinal

I want to behave similar other people like me regarding care of daughters NT21 - PW ordinal

Confident that I can ensure my daughters get enough food and attention NT22 + PW ordinal

Determined to ensure my daughters get enough food and attention NT24 + PW ordinal

It is entirely up to me to decide on whether daughters get enough food and attention NT23 + PW ordinal

Enough food and attention for daughter is protective against disease and malnutrition NT26 + PW ordinal

H25 Feels confident enough to cook more food if not enough food left for her AN03 + AG ordinal

H26 Husband supports her in visiting SHG meetings WE5 + PW binary

Goes to fewer meetings due to lack of support from husband and family WE7 - PW binary

Group 3 H27 Intake of important micronutrients FD01-FD03 + H real

Fraction of consumption expenditure on important micronutrients FD01,FD04,FD05 + H real

Number of Vitamin A doses received by last child in last six months UC56 + FH integer

IFA tablet/sirup administered to last child in last three months UC57 + FH binary

20

Other child ever received Vitamin A dosis AC10 + FH binary

Other child ever received mulitvitamin sirup or tablets or capsules AC11 + FH binary

H28 Opinion of H on balanced nutrition of family members NT07 + H ordinal

People who H respects agree that family members should get balanced nutrition NT08 + H binary

Opinions of respected persons family diet matter to HH head NT09 - H binary

H wants to comply with family feeding of other people similar to him NT11 - H binary

H is confident that he is able to feed family good balance of food NT12 + H binary

H is determined to ensure that he feeds family good balance of food NT14 + H binary

Good balance of food is protective against disease and malnutrition NT16 + H binary

PW or children cut size of meal instead of father NT5 - PW binary

Importance of ensuring balanced diet to family NT7 + PW ordinal

Most people I respect agree that balanced diet is important NT8 + PW ordinal

Opinion of people I respect matters to me when it comes to balanced diet for family NT9 - PW ordinal

Most people like me ensure balanced diet NT10 + PW ordinal

I want to behave similar other people like me when it comes to balanced diet for family NT11 - PW ordinal

I am confident to be able to feed balanced diet to family NT12 + PW ordinal

PW decides about family diet NT13 + PW binary

I am determined to feed balanced diet to family NT14 + PW ordinal

I have previously fed balanced diet to family NT15 + PW ordinal

A good balance of food will protect family from disease and malnutrition NT16 + PW ordinal

H29 Plans to or is breastfeeding child CC2 + PW binary

Believes breastfeeding is important CC1 + PW binary

Someone suggested that child should not be breastfed CC4 - PW binary

Opinion on feeding thick, yellowish breastmilk after delivery (not important - very important) CC6 + PW ordinal

People I respect think that feeding thick, yellowish breastmilk is important CC7 + PW ordinal

Opinion of people I respect matters to me when it comes to child feeding CC8 - PW ordinal

Most people like me feed thick, yellowish breastmilk to babies CC9 + PW ordinal

I want to behave similar to people like me when it comes to child feeding CC10 - PW ordinal

Confident to be able feed thick, yellowish breastmilk to babies CC11 + PW ordinal

Decides about feeding thick, yellowish breastmilk to babies on her own CC12 + PW binary

Determined to feed thick, yellowish breastmilk to babies CC13 + PW ordinal

Previously fed thick, yellowish breastmilk to babies CC15 + PW ordinal

Thick, yellowish breastmilk helps to protect baby from malnutrition and disease CC16 + PW binary

Complementary feeding after six months is important CC17 + PW ordinal

People I respect think complementary feeding should start after six months CC18 + PW ordinal

Most people like me start complementary feeding of children after six months CC19 + PW ordinal

Confident to be able to start complementary feeding of children after six months CC20 + PW ordinal

Would decide about complementary feeding on her own CC22 + PW ordinal

Previously started complementary feeding of children after six months CC23 + PW ordinal

Complementary feeding after six months protects baby from malnutrition and disease CC24 + PW ordinal

Adding oil to every meal of children between 6 and 59 months is important CC25 + PW ordinal

People I respect agree that we should add oil CC26 + PW ordinal

Most people like me add oil CC27 + PW ordinal

Confident to be able to add oil when feeding last child CC28 + PW ordinal

Decides on her own about adding oil CC29 + PW ordinal

Determined to add oil when feeding last child CC30 + PW ordinal

Previously added oil CC31 + PW ordinal

21

Adding oil helps to protect child from malnutrition CC32 + PW ordinal

Opinion on feeding thick, yellowish breastmilk after delivery UC24 + FH ordinal

People I respect think that feeding thick, yellowish breastmilk is important UC25 + FH ordinal

Opinion of people I respect matters to me when it comes to child feeding UC26 - FH ordinal

Most people I know feed thick, yellowish breastmilk to babies UC27 + FH ordinal

I want to behave similar to people like me when it comes to child feeding UC29 - FH ordinal

Determined to feed thick, yellowish breastmilk to babies UC30 + FH ordinal

Thick, yellowish breastmilk helps to protect baby from malnutrition and disease UC32 + FH ordinal

Timing of first breastfeeding counting from date of birth (less means earlier) UC33 - FH ordinal

Opinion of complementary feeding of children after six months UC36 + FH ordinal

People I respect think complementary feeding should start after six months UC37 + FH ordinal

Most people like me start complementary feeding of children after six months UC38 + FH ordinal

Determined to start complementary feeding of children after six months UC40 + FH ordinal

Complementary feeding after six months protects baby from malnutrition and disease UC42 + FH ordinal

Gave last child pre-lacteral feeding on day of birth UC43 + FH binary

How often breastfeeding per day UC45 + FH ordinal

Duration of last breastfeeding episode in days/months UC46 + FH integer

Number of times last born child ate yesterday UC47 + FH integer

Opinion on adding oil to every meal of children between 6 and 59 months UC48 + FH ordinal

People I respect agree that we should add oil UC49 + FH ordinal

Most people like me add oil UC50 + FH ordinal

Confident to be able to add oil when feeding last child UC51 + FH ordinal

Determined to add oil when feeding last child UC53 + FH ordinal

Adding oil helps to protect child from malnutrition UC55 + FH ordinal

H30 Last child has all necessary vaccinations UC65 + Obs binary*

Other child has all necessary vaccinations AC13 + Obs binary*

Possess child vaccination card UC64 + FH binary

Last child sleeps under betnet UC66 + FH binary

Betnet of last child is treated UC67 + FH binary

Last child given any drug against intestinal worms in last six months UC58 + FH binary

Other child ever given any drug against intestinal worms AC12 + FH binary

H31 Smokes cigarettes or chews tobacco AN06 - AG ordinal

Smokes HB3 - PWH binary

Number of cigarettes per day HB3 - PWH ordinal

Chews tabacco on a daily basis HB4 - PWH binary

Number of times per day chews tabacco HB4 - PWH ordinal

Smokes WH06 - FH binary

Smokes GH7 - PW binary

Number of cigarettes per day WH06 - FH integer

Number of cigarettes per day GH7 - PW integer

Chews tabacco on a daily basis WH07 - FH binary

Chews tabacco on a daily basis GH8 - PW binary

Number of times per day chews tabacco WH07 - FH integer

Number of times per day chews tabacco GH8 - PW integer

Drinks alcoholic beverages HB5 - PWH binary

Number of alcoholic drinks per weak HB5 - PWH ordinal

Drinks more than two cups or caffeniated chai per day WH05 - FH binary

22

Drinks more than two cups or caffeniated chai per day GH5 - PW binary

H32 Household treats water adequatly HV07, HV08 + H binary*

Household of pregnant woman treats water adequatly HV7,HV8 + PW binary

Stored water contaminated with e.coli HV13 - Obs binary

H33 Frequency of buying soap HV14 + H ordinal

Improved toiled in HH HV15 + Obs binary*

Cleanliness of toilet HV17 + Obs binary

Stool piles or sewage water nearby HV18 - Obs binary*

Adequate stool disposal of infant HV19 + H binary*

Open defecation despite toilet by any HH member HV20 - H binary

H ever reprehended open defecation by others near own house HV22 + H binary

H believes open defecation is health hazard HV23 + H binary

H opinion of using toilets or covering excreta with mud HV24 + H ordinal

People who HH head respects agree that one should use toilet or cover excreta with mud HV25 + H ordinal

Opinions of respected persons on toiled use matter to HH head HV26 - H ordinal

H wants to comply with toilet behavior of other people similar to him HV28 - H ordinal

H is confident that he is able to use toilet/cover extreta with mud HV29 + H ordinal

H is determined to ensure that he uses toilet/cover extreta with mud HV31 + H ordinal

H uses soap after toilet HV34 + H binary*

H uses soap before meals HV34 + H binary*

Frequency of soap usage by HH head HV35 + H ordinal

Frequency of baths by HH members HV36 + H ordinal

Importante of using toilets or covering excreta with mud SB1 + PW ordinal

People who I respect agree that one should use toilet or cover excreta with mud SB2 + PW binary

Opinions of respected persons on toiled use matter to me SB3 - PW binary

Most people like me use toilet or cover excreta with mud SB4 + PW binary

PW wants to comply with toilet behavior of other people similar to her SB5 - PW ordinal

PW is confident that he is able to use toilet/cover extreta with mud SB6 + PW ordinal

PW is determined to ensure that he uses toilet/cover extreta with mud SB8 + PW ordinal

PW decides about toilet use SB7 + PW binary

PW has previously used toilet or covered excreta with mud SB9 + PW binary

Using toiled or covering excreta with mud protects me and everyone in village from disease SB10 + PW binary

H34 Seen/heard/read messages about malaria/dengue programme WH10 + FH binary*

Seen/heard/read messages about diarrhea WH10 + FH binary*

Seen/heard/read messages about acute respiratory infection WH10 + FH binary*

Seen/heard/read messages about STI WH10 + FH binary*

Knows danger signs of malaria WH11 + FH binary*

Knows danger signs of acute respiratory infection WH12 + FH binary*

Knows what to do when child has diarrhea WH13 + FH binary*

Seen/heard/read messages about malaria/dengue/chikungunya programme GH13 + PW binary

Knows danger signs of malaria GH14 + PW binary

H35 Number of known family planning methods RH06 + FH integer

Contraception currently used by FH or partner RH07 + FH binary

Knows were to get the pill AS03 + AG binary

Knows were to get emergency contraception AS03 + AG binary

Knows were to get condom or nirodh AS03 + AG binary

Knows were to get female condom AS03 + AG binary

23

Believes condoms are effective contraception AS04 + AG binary

Believes condoms can be used more than once AS04 - AG binary

Believes condoms are effective HIV/AIDS protection AS04 + AG binary

Buying or obtaining condoms would be too embarrising AS04 - AG binary

Believes a girl who suggest to her partner to use a condom, does not trust him AS04 - AG binary

Believes that condoms can slip of a man and disappear inside a woman's body AS04 + AG binary

Believes condoms are effective protection against STD AS04 + AG binary

Has discussed contraception with anybody AS05 + AG binary*

Believes pregnancy can occur after kissing or hugging AS06 - AG binary

Believes woman has to bleed at first intercourse AS06 - AG binary

Believes woman can get pregnant at first intercourse AS06 + AG binary

Believes woman stops growing after first intercourse AS06 - AG binary

Pregnancy risk highest at half-way between periods AS06 + AG binary

Uses tampons or female pads during period AS07 + AG binary*

Group 4 H36 Hours per week worked inside house GH20 - PW integer

Housework includes harmful activities for pregnant women GH21 - PW binary

Hours per week worked outside GH22 - PW integer

Work outside includes harmful activities for pregnant women GH23 - PW binary

Plans to continue work throughout pregnancy GH24 + PW binary

Hours per week sleeping GH25 + PW integer

Hours per week resting in the afternoon GH25 + PW integer

Hours per week performing leasure activities GH25 + PW integer

More careful to prevent malaria since knows about pregnany GH17 + PW binary

Drinks alcoholic beverages GH10 - PW binary

Number of drinks per week GH10 - PW ordinal

Drank alcoholic beverages since found out about pregnancy GH10 - PW binary

Number of drinks per week GH10 - PW ordinal

Sleeps under bednet GH15 + PW binary

Bednet is treated GH16 + PW binary

Salt contains iodine GH19 + Obs binary

Number of meals per day NT1 + PW integer

Eats more (or more often) since pregnant NT3 + PW binary

Pay closer attention to balanced diet since pregnancy NT3 + PW binary

H37 Saw anyone for antenatal care during pregnancy CP6 + PW binary

Antenatal care performed by skilled health personnel CP9 + PW binary

Antenatal care performed in health facility CP10 + PW binary

Number of antenatal care visits CP11 + PW integer

Number of planned antenatal care visits CP12 + PW integer

Number of months until first antenatal care visit CP13 - PW integer

Received antenatal care when wanted CP14 - PW integer

Was informed during antenatal care about baby blues CP15 + PW binary

Was informed during antenatal care about work during pregnancy CP15 + PW binary

Was informed during antenatal care about baby breastfeeding CP15 + PW binary

Was informed during antenatal care about baby keeping the baby warm CP15 + PW binary

Was informed during antenatal care about baby need for cleanliness at delivery CP15 + PW binary

Was informed during antenatal care about family planning for spacing CP15 + PW binary

Was informed during antenatal care about family planning for limiting CP15 + PW binary

24

Was informed during antenatal care about maternal nutrition CP15 + PW binary

Was informed during antenatal care about child nutrition CP15 + PW binary

Was informed during antenatal care about need for institutional delivery CP15 + PW binary

Was informed during antenatal care about danger of malaria infection CP15 + PW binary

Was informed during antenatal care about danger signs to look out for CP16 + PW binary

Was informed during antenatal care about bleeding CP17 + PW binary

Was informed during antenatal care about convulsions CP17 + PW binary

Was informed during antenatal care about prolonged labor CP17 + PW binary

Was informed during antenatal care about preterm labor CP17 + PW binary

Was told were to go in case of complications CP18 + PW binary

Blood pressure measured during antenatal care CP19 + PW binary

Weight measured during antenatal care CP20 + PW binary

Urine sample taken during antenatal care CP21 + PW binary

Blood sample taken during antenatal care CP22 + PW binary

Ultrasound test during pregnancy CP29 + PW binary

Received tetanus injection during pregnancy CP30 + PW binary

Number of tetanus injections during pregnancy CP31 + PW integer

Number of iron & folic acid tablets/bottles during pregnancy CP34 + PW integer

Duration of iron & folic acid intake in days CP35 + PW integer

Other nutritional supplements during pregnancy CP36 + PW binary

H38 Was accompanied by anyone to antenatal care CP23 + PW binary

Was accompanied by husband to antenatal care CP24 + PW binary

H39 Satisfaction of antenatal care CP25 + PW ordinal

Satisfied with waiting time CP26 + PW binary

Satisfied with number of visits CP26 + PW binary

Satisfied withamount of time with health staff CP26 + PW binary

Satisfied with advice and information CP26 + PW binary

Satisfied with understanding and respect CP26 + PW binary

H40 Happiness with pregnancy CP3 + PW ordinal

How often stressed or strongly worried in last 12 months GH26 + PW ordinal

Worried about not knowing how to care for baby CP4 - PW binary

Thinks baby will keep her from things she is used to CP4 - PW binary

Looks forward to teaching and caring for baby CP4 + PW binary

Looks forward to new experience that baby brings CP4 + PW binary

Looks forward to telling friends and family about pregnancy CP4 + PW binary

Worried about money CP4 - PW binary

Does not look forward to telling friends and family about pregnancy CP4 - PW binary

Has possibility in household to adapt to challenges of pregnancy CP5 + PW binary

Feeling when got to know about pregnancy (very unhappy to very happy) RH13 + PW ordinal

Partner's feeling when got to know about pregnancy (very unhappy to very happy) RH14 + PW ordinal

H41 Knows about abortion RH7 + PW binary

Knows were to get safe abortion RH8 + PW binary

Would discuss abortion jointly with partner RH9 + PW binary

Group 5 H42 Number of times visited nearest Anganwadi health center in last 3 months WH09 + FH integer

Number of pregnant women in register in month before interview FS19 + AW integer

Number of pregnant women approached by AW FS19 + AW integer

Number of pregnant women coming to Anganwadi on their own initiative FS19 + AW integer

25

Number of lactating women in register in month before interview FS20 + AW integer

Number of lactating women approached by AW FS20 + AW integer

Number of lactating women coming to Anganwadi on their own initiative FS20 + AW integer

Number of children in register in month before interview FS19 + AW integer

Number of children approached by AW FS19 + AW integer

Number of children coming to Anganwadi on their own initiative FS19 + AW integer

Number of adolescent girls in register in month before interview FS20 + AW integer

Number of adolescent girls approached by AW FS20 + AW integer

Number of adolescent girls coming to Anganwadi on their own initiative FS20 + AW integer

H43 Number of children having recovered from severe malnutrition since attenting facility FS24 + AW integer

Number of hot cooked meals given out at facility in certain month before interview FS25 + AW integer

Number of meals per child between 3 and 6 years per day at facility FS26 + AW integer

Able to provide items for hot cooked meals FS30 + AW binary

Provides take-home rations as per norm FS30 + AW binary

Keeps stock of IFA doses in center PA04 + AW binary

Keeps stock of vitamin A doses in center PA04 + AW binary

Number of vitamin A doses handed out in last seven days PA05 + AW integer

Number of girls receiving IFA doses from facility in last seven days PA06 + AW integer

H44 Records weight of children of age 5 and above on monthly basis WC01 + AW binary

Records weight of newborns up to age 5 on monthly basis WC01 + AW binary

Plots child weight on growth monitoring chart WC01 + AW binary

Functioning weighting machines available at facility FS17 + AW binary

Refers cases of children to sub centres/PHC WC01 + AW binary

Maintains child cards for children under 6 WC01 + AW binary

Produces child cards before their visits with other medical personnel WC01 + AW binary

Send children to VHSND sessions WC01 + AW binary

Performs one-to-one counseling at AWC WC01 + AW binary

H45 Facility has improved water source FS04 + AW binary*

Treats water adequatly at facility FS06 + AW binary*

Stores water adequatly at facility FS08/FS09 + AW binary*

Soap available at facility FS10 + Obs binary*

Improved toilet available at facility FS12 + AW binary*

Cleanliness of toilet at facility FS13 + Obs ordinal

Toiled is used FS14 + Obs binary

Children allowed to use toilet FS15 + AW binary

Frequency of floor cleaning FS16 + AW ordinal

H46 Pre-school children use workbook FS37 + AW ordinal

Frequency of meetings with pre-school children's parents FS38 + AW ordinal

Number of parents coming to pre-school meeting FS39 + AW integer

Content of meetings: attentance of child FS40 + AW binary

Content of meetings: cleanliness of child FS40 + AW binary

Content of meetings: perfomance of child FS40 + AW binary

Content of meetings: nutrition of child FS40 + AW binary

Content of meetings: disciplineof child FS40 + AW binary

Creative activites in session plan: drawing and painting AC02 + AW binary

Creative activites in session plan: games AC02 + AW binary

Creative activites in session plan: story sessions AC02 + AW binary

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Creative activites in session plan: toy sessions AC02 + AW binary

Creative activites in session plan: outing to some field AC02 + AW binary

Creative activities not conducted because parents did not consent AC05 - AW binary

Number of children attending organized activities AC06 + AW integer

H47 Frequency of discussion supplementary nutrition with expecting and nursing mothers SN01 + AW ordinal

Provides mothers with locally-available food recipes for supplemantary nutrition SN02 + AW binary

Number of women counseled in past 2 months CN01 + AW integer

Number of pregnant women counseled in past 2 months CN02 + AW integer

Numer of lactating women counseled in past 2 months CN03 + AW integer

Fraction of eligible women counseled on family planning in certain month before interview CN05 + AW real

H48 Able to provide space for post-natal care during village health and nutrition day (VHND) PA02 + AW binary

Mentions all important post-natal check ups when asked for what is done at VHND PA03 + AW binary

H49 Washing hands with soap is necessary KA01 + AW binary

Washing hands with soap is important: before meals KA02 + AW binary

Washing hands with soap is important: before bed KA02 + AW binary

Washing hands with soap is important: before cooking KA02 + AW binary

Washing hands with soap is important: after using the toilet KA02 + AW binary

Washing hands with soap is important: before feeding a child KA02 + AW binary

Takes action when children arrive dirty at facility KA03 + AW binary

Number of times pregnant women should go to ANC KA05 + AW integer

Knows treatments and medication women should receive during pregnancy KA06 + AW binary

Knows which maternal behavior can influence health of unborn child KA07 + AW binary

Polio vaccine is important for child health KA08 + AW binary

DPT vaccine is indispensable for child health KA08 + AW binary

BCG vaccine is indispensable for child health KA08 + AW binary

MMR vaccine is indispensable for child health KA08 + AW binary

Opinion on feeding thick-yellowish breast milk to children KA14 + AW ordinal

Timing for starting to give bottled water to children (more means later) KA15 + AW ordinal

Knows about most important methods for family planing KA16 + AW binary

Open defecation and open sewage water are health hazards KA17 + AW binary

Importance of using toilet KA18 + AW ordinal

Importance of covering excreta with mud when no toilet exists KA18 + AW ordinal

Importance of ensuring good balance of food for women KA19 + AW ordinal

Importance of ensuring good balance of food for adolescent girls KA20 + AW ordinal

Importance of providing enough food and attention to adolescent girls KA21 + AW ordinal

Opinion on providing less food to woman when she has her period (no,sometimes,yes) KA22 - AW ordinal

Importance of adolescent girls taking IFA KA23 + AW ordinal

Importance of ensuring good balance of food for children KA24 + AW ordinal

Good balance of food protects families from disease and malnutrition KA25 + AW ordinal

Importance of starting complementary feeding after age of six months KA26 + AW ordinal

Importance of adding oil to meals for children aged 6 to 59 months KA27 + AW ordinal

Able to describe how children's weight is recored in growth chart KA29 + AW ordinal

Knows implication of flat curve KA30 + AW binary

Knows implication of downward-trending curve KA30 + AW binary

Knows most important pregnancy complications KA31 + AW binary

Would recommend health facility to treat pregnancy complications KA32 + AW binary

Knows danger signs of dehydration caused by diarrhea KA33 + AW binary

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Knows danger signs of malaria KA34 + AW binary

H50 Number of pregnant women not completing recommend immunizations KA09 - AW integer

Number of pregnant women motived by AW to get immunized during past two months KA10 + AW integer

Number of lactating women not completing recommend immunizations KA11 - AW integer

Number of lactating women motived by AW to get immunized during past two months KA12 + AW integer

Possess vaccination chart KA13 + AW binary

Number of children below age of 6 fully immunized at facility FS27 + AW integer

H51 Facilitating access of SHG households to clinics: Prepares list of patiens KA28 + AW binary

Facilitating access of SHG households to clinics: Prepares report for initial check-up KA28 + AW binary

H52 Enjoyment of job as Anganwadi worker RW01 + AW ordinal

Goes out to motivate people to come to facility RW02 + AW binary

H53 Number of events organized with mahila mandal during last two months PA09 + AW integer

Number of events organized with mata samite during last two months PA09 + AW integer

Average attendance at events PA10/PA11 + AW integer

Organized a Kishori Swasthya Mela place during the last three months PA13 + AW binary

Average attendance at event PA14 + AW integer

Number of times in touch with the ASHA talking specifically about work PA15 + AW ordinal

Number of counselling sessions (KSY) held under Kishori Shakti Yojana in the last 3 months PA16 + AW integer

Number of girls attending counselling sessions under KSY and SABLA on average? PA17 + AW integer

H54 People listen to Anganwadi worker RW03 + AW ordinal

Community acts on recommendations made by Anganwadi worker RW04 + AW ordinal

Group 6 H55 Self-assessed health WH01 + FH ordinal

Self-asssessed health GH1 + PW ordinal

Often has scaly, flaky, seborrheic condition at outer nose margin WH02 - FH binary

Often has scaly, flaky, seborrheic condition at outer nose margin GH2 - PW binary

Has soft nails or nails that chip, crack or peel easily, and/or are brittle or contain ridges WH03 - FH binary

Has soft nails or nails that chip, crack or peel easily, and/or are brittle or contain ridges GH3 - PW binary

Feels chronically tired WH08 - FH binary

Feels chronically tired GH6 - FH binary

Weight AN03 + Obs binary*

Height AN04 + Obs binary*

Has oedema AN05 - Obs binary

Mid upper arm circumference AN06 + Obs real

Hemoglobin concentration AN07 + Obs real

H56 Self assessed health HB1 + PWH ordinal

Feels chronically tired HB2 - PWH binary

Weight AN03 + Obs binary*

Height AN04 + Obs binary*

Hemoglobin concentration AN07 + Obs real

H57 Last child recently had diarrhea UC59 - FH ordinal

Last child recently had acute respiratory infection UC62 - FH ordinal

Other child recently had diarrhea AC06 - FH ordinal

Other child recently had acute respiratory infection AC08 - FH ordinal

Weight AN03 + Obs binary*

Height AN04 + Obs binary*

Hemoglobin concentration AN07 + Obs real

Has oedema AN05 - Obs binary

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Mid upper arm circumference AN06 + Obs real

Group 7 H58 Believes most people in neighbourhood can be trusted SC07 + FH ordinal

Believes in neighbourhood/village someone is likely to take advantage of you SC07 - FH ordinal

People in village do not trust each other in matters of borrowing/lending money SC07 - FH ordinal

H59 Differences in caste/race/religion/sex/etc. cause problems in neighbourhood SC08 - FH binary

A star (see column format) indicates that the indicated format is obtained after recoding a variable (e.g. by collapsing different categories)

Legend

F=Facilitator

H=Household head

FH=Female household head

Obs=Observed by fieldworker

AG=Adolescent girl

PW=Pregnant woman

PWH=Husband of pregnant woman

AW=Anganwadi worker

Information taken from household surveys

Information taken from facilitator survey

Information taken from pregnant women survey

Information taken from Anganwadi worker survey

Information taken from antropometic measurement