Are community health workers effective in retaining women in the maternity care continuum? Evidence from India
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...
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BMJ Publishing Group
2019-08-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/4/e001557.full |
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| author | Kavita Singh James Thomas Smisha Agarwal Sian Curtis Gusavo Angeles Ilene Speizer |
| author_facet | Kavita Singh James Thomas Smisha Agarwal Sian Curtis Gusavo Angeles Ilene Speizer |
| author_sort | Kavita Singh |
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| description | 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. |
| format | Article |
| id | doaj-art-dc839eacd2a74e99b9238d210c8c7e98 |
| institution | OA Journals |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-08-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Global Health |
| spelling | doaj-art-dc839eacd2a74e99b9238d210c8c7e982025-08-20T02:08:46ZengBMJ Publishing GroupBMJ Global Health2059-79082019-08-014410.1136/bmjgh-2019-001557Are community health workers effective in retaining women in the maternity care continuum? Evidence from IndiaKavita Singh0James Thomas1Smisha Agarwal2Sian Curtis3Gusavo Angeles4Ilene Speizer5Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany1 Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre), Social Science Research Unit, UCL Institute of Education, University College London, London, UKUniversity of North Carolina at Chapel Hill Carolina Population Center, Chapel Hill, North Carolina, USADepartment of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USADepartment of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USADepartment of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USAObjectives 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.https://gh.bmj.com/content/4/4/e001557.full |
| spellingShingle | Kavita Singh James Thomas Smisha Agarwal Sian Curtis Gusavo Angeles Ilene Speizer Are community health workers effective in retaining women in the maternity care continuum? Evidence from India BMJ Global Health |
| title | Are community health workers effective in retaining women in the maternity care continuum? Evidence from India |
| title_full | Are community health workers effective in retaining women in the maternity care continuum? Evidence from India |
| title_fullStr | Are community health workers effective in retaining women in the maternity care continuum? Evidence from India |
| title_full_unstemmed | Are community health workers effective in retaining women in the maternity care continuum? Evidence from India |
| title_short | Are community health workers effective in retaining women in the maternity care continuum? Evidence from India |
| title_sort | are community health workers effective in retaining women in the maternity care continuum evidence from india |
| url | https://gh.bmj.com/content/4/4/e001557.full |
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