Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India.
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 Famil...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLOS Global Public Health |
| Online Access: | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002651&type=printable |
| _version_ | 1797351517816094720 |
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| author | Sujata Mishra Susan Horton Zulfiqar A Bhutta Beverley M Essue |
| author_facet | Sujata Mishra Susan Horton Zulfiqar A Bhutta Beverley M Essue |
| author_sort | Sujata Mishra |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T13:00:42Z |
| format | Article |
| id | doaj.art-caba20143a4a427993fd8f1e975fd0fa |
| institution | Directory Open Access Journal |
| issn | 2767-3375 |
| language | English |
| last_indexed | 2024-03-08T13:00:42Z |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLOS Global Public Health |
| spelling | doaj.art-caba20143a4a427993fd8f1e975fd0fa2024-01-19T06:14:42ZengPublic Library of Science (PLoS)PLOS Global Public Health2767-33752024-01-0141e000265110.1371/journal.pgph.0002651Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India.Sujata MishraSusan HortonZulfiqar A BhuttaBeverley M EssueThis 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.https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002651&type=printable |
| spellingShingle | Sujata Mishra Susan Horton Zulfiqar A Bhutta Beverley M Essue Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India. PLOS Global Public Health |
| title | Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India. |
| title_full | Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India. |
| title_fullStr | Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India. |
| title_full_unstemmed | Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India. |
| title_short | Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India. |
| title_sort | association between the use of accredited social health activist asha services and uptake of institutional deliveries in india |
| url | https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002651&type=printable |
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