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Younger and Poorer Women Favour ASHA Services, 1.6 Times More Likely to Opt for Hospitals During Childbirth: Study

Authors noted that certain states in India, and more specifically, the nine low-performing states collectively called the Empowered Action Group and Assam, have lower uptake of institution-based deliveries and a disproportionately larger number of maternal and child deaths. (Getty Images)

Authors noted that certain states in India, and more specifically, the nine low-performing states collectively called the Empowered Action Group and Assam, have lower uptake of institution-based deliveries and a disproportionately larger number of maternal and child deaths. (Getty Images)

The study found that younger women from the poorest wealth index were more likely to use ASHA services and women in rural areas had a two-fold likelihood. Conversely, women with health insurance were less likely to use ASHA services compared to those without

Services of ASHA workers are preferred by younger women in poverty and by rural residents, but less utilised by those with health insurance, a new study has found.

The study also found that ASHA workers’ services motivated mothers, making them 1.6 times more likely to choose healthcare facilities for childbirth over-delivering at home or in unsafe conditions.

Shedding light on the role of ASHA workers, who are officially known as ‘Accredited Social Health Activist’, a study published in PLOS Global Public Health on January 16 found that “ASHAs are effective in enhancing the uptake of maternal services particularly institution-based deliveries”.

The study found that younger women from the poorest families were more likely to get help from ASHA workers. Also, women living in rural areas were twice as likely to use these services. On the other hand, women with health insurance were less likely to use ASHA services compared to those without insurance.

According to the authors of the study, who are affiliated to the Institute of Health Policy, University of Toronto in Canada, only a limited number of studies have explored the likelihood of engaging with ASHA services and its influence on the utilisation of maternal health services.

They believe that, so far, there was no surety that ASHAs make a big difference in getting people to use healthcare services, especially for delivering babies in hospitals.

Impact of ASHA in Low-Performing States

Authors noted that certain states in India, and more specifically, the nine low-performing states collectively called the Empowered Action Group and Assam (EAGA), have lower uptake of institution-based deliveries and a disproportionately larger number of maternal and child deaths.

These nine states are Bihar, Chhattisgarh, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh, Jharkhand, Uttaranchal and Assam. In contrast, economically advanced states of Kerala and Tamil Nadu have higher access to and utilization of primary healthcare.

Of the 2.32 lakh women in the study’s sample, 55.5% live in EAGA states. Overall, 63.3% of women – out of which 70.6% are in EAGA states – reported utilising ASHA services, and 88.6% had an institution-based delivery (out of which 84.0% in EAGA states), the study reported.

Poorest Women More Inclined to Use ASHA Services

The study found that the younger women from the poorest wealth index were more likely to use ASHA services and women in rural areas had a two-fold likelihood. “Conversely, women with health insurance were less likely to use ASHA services compared to those without.”

“…The average treatment effect of using ASHA services on institution-based deliveries was 5.1% for all India (EAGA = 7.4%).”

According to the findings, ASHA services significantly increased the likelihood of institution-based delivery by 1.6 times for all India and 1.8 times for EAGA.

“Our study finds that ASHAs are effective in enhancing the uptake of maternal services particularly institution-based deliveries,” the authors of the study concluded.

They added that “these findings underscore the necessity for continual, systematic investments to strengthen the ASHA program and to optimize the program’s effectiveness in varied settings that rely on the community health worker model, thereby advancing child and maternal health outcomes.”

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