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Background   Chamas for Change (Chamas)  is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between  Chamas  participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors.    Methods  We prospectively compared outcomes between a cohort of  Chamas  participants and controls matched for age, parity, and prenatal care location. Between October–December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in  Chamas . Women enrolled in  Chamas  agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05.    Results  Compared to controls ( n  = 115), a significantly higher proportion of  Chamas  participants ( n  = 211) delivered in a health facility (84.4% vs. 50.4%,  p  < 0.001), attended at least four ANC visits (64.0% vs. 37.4%,  p  < 0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p < 0·001), and received a CHV home visit within 48 h postpartum (75.8% vs. 38.3%, p < 0·001). In multivariable models,  Chamas  participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12–9.64,  p  < 0.001). Though not significant,  Chamas  participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls.    Conclusions   Chamas  participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate  Chamas’  potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.    Trial registration  ClinicalTrials.gov,  NCT03188250  (retrospectively registered 31 May 2017).

bmc pregnancy and childbirth

Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya