Disparities in Maternal Health Service Utilization and the Role of Community Health Worker in India

Background and Purpose: Programs within India have focused on incentivizing delivery at health facility and introducing the community health worker or ASHA worker as a strategy to improve maternal health outcomes. We examined the factors influencing delivery at health facility and the role of the community health worker in shaping choice of place of delivery and reducing maternal health disparities.

Methods: We used data from the India Human Development Survey-II conducted in 2011-12, and extracted an analytic sample of women (N= 8,711) who reported having at least one child since 2005. Logistic regression analysis was used to examine influence of predisposing factors, frequency of antenatal care (ANC) visits and visit by ASHA worker on likelihood of delivery at health facility.

Results: There were considerable disparities in utilization of maternal health services based on religion, caste, education and household wealth. Older women, those with higher number of children, and those belonging to Muslim religion had lower odds of delivery at health facility; while higher age of spouse, increased age at marriage, higher levels of education, household wealth, caste and urban residence were associated with increased odds of delivery at health facility. About 26% of the women had any exposure to an ASHA worker; these women had three times the odds of delivery at health facility (OR= 3.01, p<0.001, 95% CI: 2.35, 3.86) compared to those who had no exposure to the ASHA workers.

Conclusions and Implications: There is a need for social work research to focus on understanding culturally appropriate interventions aimed at reducing disparities in access to antenatal care and delivery at health facility. Furthermore, the community health worker or ASHA worker may have a crucial role in promoting antenatal care, thereby strengthening the association between ANC contacts and maternal health service utilization. Further research is required to understand impact of visit by community health worker on women’s choices in relation to place of delivery and the role of social worker in facilitating this interaction.