Are community health workers effective in retaining women in the maternity care continuum? Evidence from India

Smisha Kaysin, Sian Curtis, Gusavo Angeles, Ilene Speizer, Kavita Singh, James Thomas

Research output: Contribution to journalArticle

Abstract

Objectives Despite the recognised importance of adopting a continuum of care perspective in addressing the care of mothers and newborns, evidence on specific interventions to enhance engagement of women along the maternity care continuum has been limited. We use the example of the Accredited Social Health Activist (ASHA) programme in India, to understand the role of community health workers in retaining women in the maternity care continuum. Methods Using the Indian Human Development Survey data from 2011 to 2012, we assess the association between individual and cluster-level exposure to ASHA and four key components along the continuum of care - at least one antenatal care (ANC) visit, four or more ANC visits, presence of a skilled birth attendance (SBA) at the time of birth and postnatal care for the mother or child within 48 hours of birth, for 13 705 women with a live birth since 2005. To understand which of these services experience maximum dropout along the continuum, we use a linear probability model to calculate the weighted percentages of using each service. We assess the association between exposure to ASHA and number of services utilised using a multinomial logistic regression model adjusted for a range of confounding variables and survey weights. Results Our study indicates that exposure to the ASHA is associated with an increased probability of women receiving at least one ANC and SBA. In terms of numbers of services, exposure to ASHA accounts for a 12% (95% CI: 9.1 to 15.1) increase in women receiving at least some of the services, and an 8.8% (95% CI: -10.2 to -7.4) decrease in women receiving no services. However, exposure to ASHA does not increase the likelihood of women utilising all the services along the continuum. Conclusions While ASHA is effective in supporting women to initiate and continue care along the continuum, it does not significantly affect the completion of all services along the continuum.

Original languageEnglish (US)
Article numbere001557
JournalBMJ Global Health
Volume4
Issue number4
DOIs
StatePublished - Jul 1 2019

Fingerprint

Continuity of Patient Care
India
Health
Prenatal Care
Parturition
Logistic Models
Mothers
Postnatal Care
Confounding Factors (Epidemiology)
Live Birth
Human Development
Linear Models
Newborn Infant
Weights and Measures

Keywords

  • Antenatal care
  • Community health workers
  • Frontline health care workers
  • Human resources
  • India
  • Maternal health
  • Postnatal care
  • Primary healthcare
  • Skilled birth attendance
  • South Asia

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Are community health workers effective in retaining women in the maternity care continuum? Evidence from India. / Kaysin, Smisha; Curtis, Sian; Angeles, Gusavo; Speizer, Ilene; Singh, Kavita; Thomas, James.

In: BMJ Global Health, Vol. 4, No. 4, e001557, 01.07.2019.

Research output: Contribution to journalArticle

Kaysin, Smisha ; Curtis, Sian ; Angeles, Gusavo ; Speizer, Ilene ; Singh, Kavita ; Thomas, James. / Are community health workers effective in retaining women in the maternity care continuum? Evidence from India. In: BMJ Global Health. 2019 ; Vol. 4, No. 4.
@article{cd5cb7ea2d404cdfa55f354d4e7bbe91,
title = "Are community health workers effective in retaining women in the maternity care continuum? Evidence from India",
abstract = "Objectives Despite the recognised importance of adopting a continuum of care perspective in addressing the care of mothers and newborns, evidence on specific interventions to enhance engagement of women along the maternity care continuum has been limited. We use the example of the Accredited Social Health Activist (ASHA) programme in India, to understand the role of community health workers in retaining women in the maternity care continuum. Methods Using the Indian Human Development Survey data from 2011 to 2012, we assess the association between individual and cluster-level exposure to ASHA and four key components along the continuum of care - at least one antenatal care (ANC) visit, four or more ANC visits, presence of a skilled birth attendance (SBA) at the time of birth and postnatal care for the mother or child within 48 hours of birth, for 13 705 women with a live birth since 2005. To understand which of these services experience maximum dropout along the continuum, we use a linear probability model to calculate the weighted percentages of using each service. We assess the association between exposure to ASHA and number of services utilised using a multinomial logistic regression model adjusted for a range of confounding variables and survey weights. Results Our study indicates that exposure to the ASHA is associated with an increased probability of women receiving at least one ANC and SBA. In terms of numbers of services, exposure to ASHA accounts for a 12{\%} (95{\%} CI: 9.1 to 15.1) increase in women receiving at least some of the services, and an 8.8{\%} (95{\%} CI: -10.2 to -7.4) decrease in women receiving no services. However, exposure to ASHA does not increase the likelihood of women utilising all the services along the continuum. Conclusions While ASHA is effective in supporting women to initiate and continue care along the continuum, it does not significantly affect the completion of all services along the continuum.",
keywords = "Antenatal care, Community health workers, Frontline health care workers, Human resources, India, Maternal health, Postnatal care, Primary healthcare, Skilled birth attendance, South Asia",
author = "Smisha Kaysin and Sian Curtis and Gusavo Angeles and Ilene Speizer and Kavita Singh and James Thomas",
year = "2019",
month = "7",
day = "1",
doi = "10.1136/bmjgh-2019-001557",
language = "English (US)",
volume = "4",
journal = "BMJ Global Health",
issn = "2059-7908",
publisher = "BMJ Publishing Group",
number = "4",

}

TY - JOUR

T1 - Are community health workers effective in retaining women in the maternity care continuum? Evidence from India

AU - Kaysin, Smisha

AU - Curtis, Sian

AU - Angeles, Gusavo

AU - Speizer, Ilene

AU - Singh, Kavita

AU - Thomas, James

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Objectives Despite the recognised importance of adopting a continuum of care perspective in addressing the care of mothers and newborns, evidence on specific interventions to enhance engagement of women along the maternity care continuum has been limited. We use the example of the Accredited Social Health Activist (ASHA) programme in India, to understand the role of community health workers in retaining women in the maternity care continuum. Methods Using the Indian Human Development Survey data from 2011 to 2012, we assess the association between individual and cluster-level exposure to ASHA and four key components along the continuum of care - at least one antenatal care (ANC) visit, four or more ANC visits, presence of a skilled birth attendance (SBA) at the time of birth and postnatal care for the mother or child within 48 hours of birth, for 13 705 women with a live birth since 2005. To understand which of these services experience maximum dropout along the continuum, we use a linear probability model to calculate the weighted percentages of using each service. We assess the association between exposure to ASHA and number of services utilised using a multinomial logistic regression model adjusted for a range of confounding variables and survey weights. Results Our study indicates that exposure to the ASHA is associated with an increased probability of women receiving at least one ANC and SBA. In terms of numbers of services, exposure to ASHA accounts for a 12% (95% CI: 9.1 to 15.1) increase in women receiving at least some of the services, and an 8.8% (95% CI: -10.2 to -7.4) decrease in women receiving no services. However, exposure to ASHA does not increase the likelihood of women utilising all the services along the continuum. Conclusions While ASHA is effective in supporting women to initiate and continue care along the continuum, it does not significantly affect the completion of all services along the continuum.

AB - Objectives Despite the recognised importance of adopting a continuum of care perspective in addressing the care of mothers and newborns, evidence on specific interventions to enhance engagement of women along the maternity care continuum has been limited. We use the example of the Accredited Social Health Activist (ASHA) programme in India, to understand the role of community health workers in retaining women in the maternity care continuum. Methods Using the Indian Human Development Survey data from 2011 to 2012, we assess the association between individual and cluster-level exposure to ASHA and four key components along the continuum of care - at least one antenatal care (ANC) visit, four or more ANC visits, presence of a skilled birth attendance (SBA) at the time of birth and postnatal care for the mother or child within 48 hours of birth, for 13 705 women with a live birth since 2005. To understand which of these services experience maximum dropout along the continuum, we use a linear probability model to calculate the weighted percentages of using each service. We assess the association between exposure to ASHA and number of services utilised using a multinomial logistic regression model adjusted for a range of confounding variables and survey weights. Results Our study indicates that exposure to the ASHA is associated with an increased probability of women receiving at least one ANC and SBA. In terms of numbers of services, exposure to ASHA accounts for a 12% (95% CI: 9.1 to 15.1) increase in women receiving at least some of the services, and an 8.8% (95% CI: -10.2 to -7.4) decrease in women receiving no services. However, exposure to ASHA does not increase the likelihood of women utilising all the services along the continuum. Conclusions While ASHA is effective in supporting women to initiate and continue care along the continuum, it does not significantly affect the completion of all services along the continuum.

KW - Antenatal care

KW - Community health workers

KW - Frontline health care workers

KW - Human resources

KW - India

KW - Maternal health

KW - Postnatal care

KW - Primary healthcare

KW - Skilled birth attendance

KW - South Asia

UR - http://www.scopus.com/inward/record.url?scp=85069780691&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069780691&partnerID=8YFLogxK

U2 - 10.1136/bmjgh-2019-001557

DO - 10.1136/bmjgh-2019-001557

M3 - Article

C2 - 31406590

AN - SCOPUS:85069780691

VL - 4

JO - BMJ Global Health

JF - BMJ Global Health

SN - 2059-7908

IS - 4

M1 - e001557

ER -