Community-Based Health Promotion Intervention to Improve Household Decision-Making During the Perinatal Period: A Quasi-Experimental Study in Sri Lanka

Improving household decision-making during the perinatal period is a vital strategy for reducing low birth weight. In Sri Lanka, the prevalence of low birth weight has remained close to 17% for nearly two decades, and evidence on community-based participatory approaches to improving collective decision-making among pregnant women remains scarce. This quasi-experimental study, conducted between January and October 2022, evaluated a community-based health promotion intervention to improve collective household decision-making among 403 pregnant mothers in the North Central Province of Sri Lanka (intervention group: Anuradhapura district; comparison group: Polonnaruwa district). Grounded in an established, community-centred health promotion process model, the intervention was delivered through 71 Neighbourhood Action Committees using six community-developed participatory tools addressing community-identified determinants of poor household decision-making. Collective decision-making during pregnancy was significantly higher in the intervention group than the comparison group for five of six indicators (all p < .05), with the largest differences for “items to buy for delivery” (58% vs. 36%) and “when to seek medical care” (64% vs. 50%). Postpartum collective decision-making on newborn expenditure and food and clothing spending was also significantly higher in the intervention group; decision-making on social activities and investments did not differ significantly between groups. Qualitative framework analysis identified five themes, including transformed spousal roles, enhanced financial dialogue, and increased maternal agency. Community-based participatory approaches using locally developed monitoring tools can significantly improve household-level collective decision-making during the perinatal period, contributing to greater equity in maternal health. Integration into routine antenatal services in lower-middle-income countries is recommended.