CCHE Seminar Series: Association Between the Use of Accredited Social Health Activist (ASHA) Services and Uptake of Institutional Deliveries in India

Association Between the Use of Accredited Social Health Activist (ASHA) Services and Uptake of Institutional Deliveries in India

Sujata Mishra
University of Toronto

Friday February 16, 2024, 10am-12pm, HSB Rm. 412 and Zoom

Abstract: This study examines the impact of accredited social health activists (ASHAs), on increasing rates of institution-based deliveries among Indian women with a specific focus on the nine low-performing, empowered action group states and Assam (EAGA) in India. Using the latest round of the National Family Health Survey-V (2019–21), we first investigate the association between the use of ASHA services and socio-demographic attributes of women using a multivariate logistic regression. We then use propensity-score matching (PSM) to address observable selection bias in the data and assess the impact of ASHA services on the likelihood of institution-based deliveries using a generalized estimating equations model. Of the 232,920 women in our sample, 55.5% lived in EAGA states. Overall, 63.3% of women (70.6% in EAGA states) reported utilizing ASHA services, and 88.6% had an institution-based delivery (84.0% in EAGA states). 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. Using PSM, the average treatment effect of using ASHA services on institution-based deliveries was 5.1% for all India (EAGA = 7.4%). The generalized estimating equations model indicated that the use of ASHA services significantly increased the likelihood of institution-based delivery by 1.6 times (95%CI = 1.5–1.7) for all India (EAGA = 1.8; 95%CI = 1.7–1.9). Our study finds that ASHAs are effective in enhancing the uptake of maternal services particularly institution-based deliveries. 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.

Sujata, a Health Economist and PhD Candidate in Health Services Research at the Institute of Health Policy, Management, and Evaluation (University of Toronto), specializes in Health Economics and Global Health. She is interested in advancing health services research by exploring the role of structural and social determinants of health in underlying health risks, health-seeking behaviors, access, and equity, particularly within marginalized populations in resource-limited settings. Her areas of interest spans maternal and child health, economic burden of non-communicable diseases, gender-based violence, sexually transmitted diseases, and the health workforce. Currently, her doctoral research focuses on evaluating the impact of community health workers on maternal and child health in low and middle-income countries. Emphasizing the role of financial incentives, Sujata advocates for fair wages and optimal working conditions to enhance the performance and motivation of these crucial healthcare providers.