• Int J Equity Health · Mar 2017

    Comparative Study

    Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: a link between social inequities and health disparities.

    • Aparna Seth, Shweta Tomar, Kultar Singh, Dharmendra Chandurkar, Amit Chakraverty, Arnab Dey, Arup K Das, Katherine Hay, Niranjan Saggurti, Sabrina Boyce, Anita Raj, and Jay G Silverman.
    • Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA. aparnas@princeton.edu.
    • Int J Equity Health. 2017 Mar 7; 16 (1): 46.

    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.

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