Abstract
BackgroundUttar Pradesh (UP) accounts for the largest number of neonatal deaths in India. This study explores potential socio-economic inequities in household-level contacts by community health workers (CHWs) and whether the effects of such household-level contacts on receipt of health services differ across populations in this state.MethodsA multistage sampling design identified live births in the last 12 months across the 25 highest-risk districts of UP (N = 4912). Regression models described the relations between household demographics (caste, religion, wealth, literacy) and CHW contact, and interactions of demographics and CHW contact in predicting health service utilization (> = 4 antenatal care (ANC) visits, facility delivery, modern contraceptive use).ResultsNo differences were found in likelihood of CHW contact based on caste, religion, wealth or literacy. Associations of CHW contact with receipt of ANC and facility delivery were significantly affected by religion, wealth and literacy. CHW contact increased the odds of 4 or more ANC visits only among non-Muslim women, increased the odds of both four or more ANC visits and facility delivery only among lower wealth women, increased the odds of facility delivery to a greater degree among illiterate vs. literate women.ConclusionCHW visits play a vital role in promoting utilization of critical maternal health services in UP. However, significant social inequities exist in associations of CHW visits with such service utilization. Research to clarify these inequities, as well as training for CHWs to address potential biases in the qualities or quantity of their visits based on household socio-economic characteristics is recommended.
Highlights
IntroductionThis study explores potential socio-economic inequities in household-level contacts by community health workers (CHWs) and whether the effects of such household-level contacts on receipt of health services differ across populations in this state
Uttar Pradesh (UP) accounts for the largest number of neonatal deaths in India
All the districts of the state were ranked on a composite index of indicators which comprised of maternal mortality ratio (MMR), percentage of safe deliveries, infant mortality rate (IMR), percentage of children 12–23 months fully immunized, total fertility rate (TFR) and contraceptive prevalence rate (CPR) – modern method, with the 25 most poorly performing districts designated as High Priority Districts (HPDs) [25]
Summary
This study explores potential socio-economic inequities in household-level contacts by community health workers (CHWs) and whether the effects of such household-level contacts on receipt of health services differ across populations in this state. Despite the progress in provision of health care access, India’s health system continues to struggle with the challenge of addressing inequalities in utilization of maternal and reproductive health services based on demographic characteristics [1,2,3]. In the Indian and other national contexts, studies suggest the protective effects of antenatal care, institutional delivery and use of modern contraceptives (via smaller numbers and more widely spaced births) on infant and maternal mortality [7,8,9,10,11,12]. ASHAs provide a variety of services to households, including the delivery of basic health care, health education, and promoting uptake of facility-based health care, antenatal care and facility delivery [15]
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