Andrea Katryn Blanchard, Tim Colbourn, Audrey Prost, Banadakoppa Manjappa Ramesh, Shajy Isac, John Anthony, Bidyadhar Dehury, Tanja A J Houweling
India’s National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to visit and counsel women before and after birth. Little is known about the extent to which exposure to ASHAs’ home visits has reduced perinatal health inequalities as intended. This study aimed to examine whether ASHAs’ third trimester home visits may have contributed to equitable improvements in institutional delivery and reductions in perinatal mortality rates (PMRs) between women with varying education levels in Uttar Pradesh (UP) state, India.
Cross-sectional survey data were collected from a representative sample of 52 615 women who gave birth in the preceding 2 months in rural areas of 25 districts of UP in 2014-2015. We analysed the data using generalised linear modelling to examine the associations between exposure to home visits and education-based inequalities in institutional delivery and PMRs.
Third trimester home visits were associated with higher institutional delivery rates, in particular public facility delivery rates (adjusted risk ratio (aRR) 1.32, 95% CI 1.30 to 1.34), and to a lesser extent private facility delivery rates (aRR 1.09, 95% CI 1.04 to 1.13), after adjusting for confounders. Associations were stronger among women with lower education levels. Having no compared with any third trimester home visits was associated with higher perinatal mortality (aRR 1.18, 95% CI 1.09 to 1.28). Having any versus no visits was more highly associated with lower perinatal mortality among women with lower education levels than those with the most education, and most notably among public facility births.
The results suggest that ASHAs’ home visits in the third trimester contributed to equitable improvements in institutional deliveries and lower PMRs, particularly within the public sector. Broader strategies must reinforce the role of ASHAs’ home visits in reaching the sustainable development goals of improving maternal and newborn health and leaving no one behind.
Citation: Blanchard AK, Colbourn T, Prost A, Ramesh BM, Isac S, Anthony J, Dehury B, Houweling TAJ. Associations between community health workers’ home visits and education-based inequalities in institutional delivery and perinatal mortality in rural Uttar Pradesh, India: a cross-sectional study. BMJ Open. 2021 Jul 12;11(7):e044835. doi: 10.1136/bmjopen-2020-044835. PMID: 34253660; PMCID: PMC8276308.
ASHAs act as an interface between the community and the public health system in creating awareness on health and its social determinants within the community, and mobilizing the community towards local health planning and increased utilization of health services. This brief highlights importance of building capacities of ASHAs through the cluster meeting platform.
This brief identifies the opportunity gaps in the effective coverage cascade for prevention of anaemia among pregnant women in India. The effective coverage cascade is used to identify coverage gaps, quantify coverage at each step, determine where the largest gaps exist within the cascade and prioritize where actions are most urgent. The findings are based on NFHS 5 data.
The fifteenth edition of PAHAL newsletter throws light on UP TSU’s support to GoUP in adopting a scientific approach for allocating Area of Responsibility (AoR) to ANMs working in sub-centres; also, geo-mapping of more than 1,80,000 Anganwadi Centres across the state by ICDS department with the support of UP TSU has been the highlight of the quarter.