Background There is a growing public policy focus on empowerment for individuals and communities, and a belief that this may also reduce health inequalities. Our theory-driven systematic review of observational evidence on pathways between control and health revealed that low female control/empowerment was associated with adverse health outcomes and reduced survival for girls and women. We conducted a systematic review to address the question: what is the impact on health-related outcomes of interventions to improve the level of control in the living environment, differentiated by socio-economic status, gender, or ethnicity? Findings on women’s microfinance initiatives are presented here.
Methods Studies were identified by searching seven bibliographic databases, screening reference lists, consulting key informants and searching organisational websites. All types of experimental and quasi-experimental study designs addressing the review question were included. Two reviewers carried out screening, data extraction and quality appraisal; disagreements were resolved through discussion with the wider team. Narrative synthesis of study findings drew upon conceptual frameworks developed in our previous review of pathways and the levels (micro/meso/macro) at which interventions might operate.
Results From 17,361 initial records we identified 10 studies (one cluster-randomised control trial and 9 quasi-experimental studies) that met our inclusion criteria and evaluated the impact of microfinance initiatives. The interventions operated at the meso/community-level, via women’s empowerment, whilst also seeking to influence the macro/societal-level by raising the status of women. All were from low-to-middle income countries and targeted poor rural women. Nine of the 10 studies provided evidence of associations between participation in microfinance schemes and improvements in health-related outcomes (reduction in interpersonal violence against women and infant and child mortality, and increases in use of family planning methods and health services) when compared with non-participation. One study found a higher probability of women ever experiencing interpersonal violence among participants compared to non-participants.
Conclusion Results from the microfinance studies reveal the potential health impact of attempts to influence control in the living environment by this type of intervention; providing rare evidence of a reduction in gender and socio-economic inequalities in health by purposeful theory-based programmes. More than 5 million poor rural women in Bangladesh alone are involved in such programmes. As the renewed focus on microfinance schemes grows in the UK and across the world, there is a need to learn from these evaluations. Future intervention studies should employ a robust research design to examine control/empowerment outcomes as well as differential impacts on health and wellbeing.
- social determinants of health
- health inequalities