Impact of intervention on reproductive health and nutritional status among migratory women workers in sugarcane harvesting

Introduction

Migration for sugarcane harvesting is a widespread seasonal livelihood strategy in several regions of India, particularly in states like Maharashtra and Karnataka, where large numbers of rural households migrate in search of employment (Food and Agriculture Organization, 2019; International Labour Organization, 2020) [2,4] . Among these migrant populations, women constitute a significant proportion of the workforce and play a dual role as both income earners and primary caregivers (Rao and Raju, 2020) [7] . Despite their substantial contribution to the agricultural economy, migratory women workers remain one of the most vulnerable and marginalized groups, often exposed to adverse living and working conditions that severely affect their health and well-being (International Labour Organization [ILO], 2020; International Institute for Population Sciences [IIPS] & Ministry of Health and Family Welfare [MoHFW], 2020) [4,3] . Reproductive health is a critical component of overall health among women, encompassing aspects such as menstrual health, maternal care, family planning, and access to healthcare services (World Health Organization, 2016) [11] . However, migratory women engaged in sugarcane harvesting face multiple challenges in maintaining reproductive health. The nature of their work involves long working hours, strenuous physical labor, lack of privacy, and inadequate sanitation facilities at worksites. Studies have reported a high prevalence of menstrual irregularities, reproductive tract infections, early age at marriage, repeated pregnancies, and limited access to antenatal and postnatal care among these women (International Institute for Population Sciences and Ministry of Health and Family Welfare, 2021) [3] . Furthermore, social and cultural barriers, coupled with low literacy levels, restrict their awareness and utilization of reproductive health services (Desai and Vanneman, 2015) [1] . Nutritional status is another crucial determinant of health, directly influencing women's productivity, reproductive outcomes, and overall quality of life (United Nations Children's Fund, 2019) [10] . Migratory women workers in sugarcane harvesting often experience poor nutritional intake due to irregular meals, food insecurity, and limited access to diverse and nutritious foods during migration periods. Their diets are typically monotonous and deficient in essential nutrients, leading to conditions such as undernutrition, anemia, and chronic energy deficiency. The high energy demands of manual labor, combined with inadequate dietary intake, further exacerbate their nutritional vulnerabilities (Rao and Raju, 2020) [7] . Additionally, repeated pregnancies and inadequate spacing between births contribute to the depletion of maternal nutritional reserves (World Health Organization, 2016) [11] . The intersection of poor reproductive health and compromised nutritional status creates a cycle of ill health among migratory women workers, affecting not only the women themselves but also the health of their children and families. These issues are further intensified by lack of access to healthcare facilities, absence of social security measures, and the temporary and mobile nature of their livelihood (International Labour Organization, 2020) [4] . Despite the growing recognition of their contribution to the agricultural sector, there remains a significant gap in research and policy interventions addressing the specific health needs of migratory women in sugarcane harvesting.

Interna tional

Methodology

The present study was conducted among migratory women workers engaged in sugarcane harvesting in Bagalkot district. A total sample of 60 respondents was selected for the study. Among them, 30 respondents were assigned to the experimental group and 30 respondents to the control group. The selection of respondents was carried out using a purposive sampling technique, wherein vulnerable women workers were identified and included in the study.

Vulnerability was determined based on factors such as poor reproductive health status, low nutritional status associated with sugarcane harvesting work. A pre-test was conducted for both groups to assess the baseline status of the respondents with respect to reproductive health and nutritional status. Following the pre-test, the experimental group was exposed to the intervention programme, while the control group continued with their routine activities without any intervention. After completion of the intervention, a post-test was conducted for both groups using the same tools and procedures as in the pre-test. The changes observed between pre-test and post-test in both groups were compared to evaluate the effectiveness of the intervention.

Tools use 1. Self-structured schedule:

A self-structured schedule was used to collect baseline information from the respondents. It consisted of basic demographic and personal data, including age, education, food habits, duration of migration, age at menarche, duration of menstrual flow, age at marriage, age at first pregnancy, spacing between children, incidence of stillbirth, breastfeeding practices, number of children, type of family, size of the family.

Reproductive health practice scale by Hassan (2002)

The scale consisted of 24 items. The scale covered questions related to conception and childbirth, safe motherhood, fertility regulation methods and sexually transmitted infections (STIs)/acquired immune deficiency syndrome (AIDS). Each item had three alternative responses: Always, Sometimes and Never, scored as 3, 2 and 1, respectively. The total score ranged from 24 to 72, with higher scores indicating better reproductive health practices. The reliability of the tool was measured using the Guttman splithalf coefficient and it was found to be 0.79, indicating acceptable internal consistency.

Category

Nutritional status assessment scale by WHO

The nutritional status of women was assessed by measuring anthropometric parameters such as weight and height. Weight was measured using a digital weighing balance, while height was measured using an anthropometric rod.

The Body Mass Index (BMI) of each woman was calculated as an indicator of nutritional status.

Body Mass Index calculation (WHO): BMI was calculated by dividing the woman's weight in kilograms (kg) by the square of height in meters (m²). The BMI values were then used to classify the nutritional status of the respondents according to standard WHO guidelines, with specific cut-off points for underweight, normal weight, overweight and obesity.

Intervention: An intervention package was developed and implemented for the respondents in the experimental group.

The intervention consisted of a total of 10 sessions, conducted once a week over a period of two and a half months. Each session was systematically planned to address the key issues related to reproductive health and nutritional status of vulnerable migratory women workers engaged in sugarcane harvesting in Bagalkot district. The sessions were delivered in a structured manner, ensuring active participation of the respondents. Appropriate teaching methods such as lectures, discussions, video, demonstrations, and interactive activities were used to enhance understanding and retention of information.The intervention programme focused on improving awareness, knowledge, and practices related to health and nutrition. Each weekly session covered specific topics, and the content was delivered progressively to build comprehensive understanding among the participants. The experimental group attended all 10 sessions during the intervention period, while the control group did not receive any form of intervention during this phase. After completion of all sessions, a post-test was conducted to assess the effectiveness of the intervention package by comparing the pre-test and post-test results.

Statistical methods:

The data collected from the respondents were systematically coded, tabulated, and analyzed using appropriate statistical methods. Descriptive statistics such as frequency and percentage were used. The Chi-square test was used to determine the association between categorical variables. The paired t-test was employed to assess the effectiveness of the intervention by comparing the pre-test and post-test mean scores of the experimental group. 1 presents the association between reproductive health and nutritional status of migratory women workers engaged in sugarcane harvesting at pre and post-test in both intervention and control groups. In the intervention group (n = 30), a marked improvement was observed in reproductive health status after the intervention. At pre-test, 60.00 percent of the women were in the poor category, 40.00 percent were in the average category and none of them in the high category. However, at post-test, 26.66 percent of women in the poor category decreased substantially while 63.34 percent moved to the average category and 10.00 percent reached the high category. The calculated Chi-square value (X² = 9.68*) indicated a statistically significant association between pre and post-test reproductive health status in the intervention group. Similar findings were reported by Desai and Vanneman, 2015 [1] , found that increased awareness and access to health services contributed to better reproductive health outcomes among women. Similarly, significant improvement was observed in nutritional status. Initially, 50.00 percent of the women were underweight, 40.00 percent had normal weight and 10.00 percent were overweight. Following the intervention, the proportion of underweight women reduced to 20.00 percent, while the normal weight category increased notably to 73.34 percent and overweight decreased to 6.66 percent. The Chi-square value (X² = 9.98*) was found to be significant, indicating that the intervention had a positive impact on nutritional status. Likewise, Rao and Raju, 2020 [7] , reported that nutrition-based interventions among women agricultural workers resulted in a decline in undernutrition and improvement in overall nutritional status. In contrast, the control group (n = 30) did not show significant changes in either reproductive health or nutritional status. In terms of reproductive health, the proportion of women in the poor category marginally decreased from 50.00 percent to 46.67 percent, while the average category slightly increased from 43.33 percent to 46.67 percent, and the high category remained almost unchanged. The Chi-square value (X² = 1.06 NS ) indicated a non-significant association. Likewise, nutritional status in the control group showed minor fluctuations, with underweight increasing slightly from 43.33 percent to 46.67 percent, normal weight decreasing from 42.33 percent to 36.67 percent, and overweight increasing marginally from 13.34 percent to 16.66 percent. The Chi-square value (X² = 2.19 NS ) was non-significant. Hence, it can be inferred that significant improvements in reproductive health and nutritional status were observed only among women who received the intervention, whereas no significant changes were noted in the control group. [9] , which reported that improved awareness and access to reproductive health information significantly enhanced women's reproductive health outcomes. Similarly, Saggurti et al. (2012) [8] [5] , which reported that nutritional interventions and awareness programmes among rural women resulted in gradual improvements in dietary intake and nutritional status, though the changes were not immediate. Similarly, Rao et al. (2014) [6] found that women from economically weaker sections showed modest improvements in nutritional status following nutrition education, emphasizing that such changes occur progressively over time.

Results and Discussion

In contrast, the control group did not show significant changes in mean scores. The mean reproductive health score increased marginally from 28.84±5.84 at pre-test to 29.12±6.13 at post-test, with a non-significant paired 't' value (t = 1.06NS). Likewise, the mean nutritional status score showed a slight increase from 17.10±5.75 to 17.83±5.98, but the paired 't' value (t = 1.08NS) was nonsignificant.

Conclusion

The present study concludes that migratory women workers engaged in sugarcane harvesting in Bagalkot district face significant challenges related to reproductive health and nutritional status due to their migratory lifestyle, occupational workload, and poor socio-economic conditions, as reflected in their low to moderate baseline health status. The structured intervention package consisting of 10 sessions over two and a half months proved to be effective in significantly improving reproductive health and bringing about a positive, though moderate, improvement in nutritional status among the experimental group, while no significant changes were observed in the control group. This clearly indicates that planned, need-based intervention programmes play a vital role in enhancing the health outcomes of vulnerable populations, and highlights the need for sustained efforts, including continuous health education, nutritional support, and broader socio-economic improvements, to achieve long-term well-being among migratory women workers.

References

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