This study examined the effect of the Safe Adolescent Transition and Health Initiative (SATHI) programme on the use of maternal care services among rural, pregnant adolescents in India. This was an intensive community-based, multi-site intervention project conducted in Maharashtra state between 2008 and 2011. Its aims were to improve the reproductive health of married adolescent girls and avert the adverse consequences of early motherhood. It had a quasi-experimental, case-control, pre-post design to enable rigorous evaluation. This study used cross-sectional data from 644 married girls aged under 19 years at baseline and 802 at endline to assess the maternal care outcomes of antenatal care, delivery and postnatal services and nutrition during pregnancy. Difference-in-differences analysis showed that all outcomes improved significantly in the study sites between baseline and endline, and the improvement in study sites was significantly larger than in the control sites. Multivariate analysis showed a statistically significant dose–response effect of intervention participation for antenatal care, pregnancy nutrition and postnatal care. Study participation was not statistically significantly associated with higher rates of safe or institutional delivery. The analysis suggests that training and supporting community health workers to work with married adolescent girls using interpersonal communication and interacting frequently with them and their families and communities can significantly improve the use of maternal care services among this population. With almost a million community health workers and 200,000 auxiliary nurse midwives at the community level providing primary level care in India, this intervention offers a proven strategy to replicate and scale-up to reach large numbers of married adolescent girls who do not currently use maternal care services.

中文翻译：

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改善已婚少女对孕产妇保健服务的使用：印度农村的一项干预研究

本研究检查了安全青少年过渡和健康倡议 (SATHI) 计划对印度农村怀孕青少年使用孕产妇保健服务的影响。这是 2008 年至 2011 年期间在马哈拉施特拉邦开展的一个密集的社区、多地点干预项目。其目的是改善已婚少女的生殖健康并避免早产的不利后果。它具有准实验性、病例对照、前后设计，以实现严格的评估。本研究使用基线时 644 名 19 岁以下已婚女孩和终点时 802 名的横断面数据来评估孕期产前保健、分娩和产后服务以及营养的孕产妇保健结果。差异中的差异分析表明，基线和终线之间研究地点的所有结果均显着改善，并且研究地点的改善明显大于对照地点。多变量分析显示，干预参与对产前保健、妊娠营养和产后保健的剂量反应效应具有统计学意义。研究参与与更高的安全或机构分娩率没有统计学上的显着相关性。分析表明，培训和支持社区卫生工作者通过人际交流与已婚少女一起工作，并经常与她们及其家人和社区互动，可以显着改善该人群对孕产妇保健服务的使用。