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.
Care during pregnancy or Antenatal care (ANC) is widely recognized as an essential element of safe motherhood. India contributes 20% of the total estimated maternal deaths that occur globally each year as per WHO estimates. Most of these maternal deaths occur during the third trimester, child-birth and the ﬁrst week after birth. The UP TSU supported the Government of Uttar Pradesh in planning and implementing community interventions to strengthen antenatal care in Uttar Pradesh rural areas.
Timely and skilled care is key to reducing maternal and neonatal mortality. Birth preparedness involves preparation for safe childbirth during the antenatal period to reach the appropriate health facility for ensuring safe delivery. This paper aims to assess the levels of birth preparedness, its determinants and association with institutional deliveries in High Priority Districts of Uttar Pradesh, India.
The 11th issue of PAHAL highlights the efforts of the Government of Uttar Pradesh (GoUP), with support from UP TSU, in converting challenges into health benefits. This includes adopting a strengthened methodology for public health denominators for better resource allocation, planning and monitoring. The issue also throws light on the GoUP Nurse Mentors’ training at the newly developed skills labs and some key digital health and family planning interventions.