ArticlePLOS global public health2024
Association between the use of Accredited Social Health Activist (ASHA) services and uptake of institutional deliveries in India.
Article in PLOS global public health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Gender differentials in death registration completeness in Gujarat, India: a policy analysis of structural, economic, and socio-cultural barriers.Frontiers in public health · 2026Article
- Understanding the drivers of effective supportive supervision: a realist evaluation of community health worker programs in Madhya Pradesh, India.BMC health services research · 2025Article
- Association of affirmative action with health and education outcomes and services in India.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- Article
- CiteSpace-based visualization and analysis of hotspots and development trends in childbirth experience research.Frontiers in global women's health · 2025Review
- More work for ASHAs? Exploring the role of whatsapp messaging and community health work in urban slum areas of Varanasi, India.PLOS global public health · 2025Article
- Coexisting traditional and biomedical healthcare systems: a mixed-methods analysis of community health workers and traditional birth attendants' contributions to perinatal health behaviors in rural India.Frontiers in health services · 2025Article
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Authors and funding
4 authors.
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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.
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