Individual and Contextual Level Impact of Accredited Social Health Activists (ASHAs) on Modern Contraceptive Use in India: A Multilevel Analysis

Catherine Moughalian , University of Groningen
Tobias C. Vogt , MPI for Demographic Research
Arathi P Rao, Manipal University
Ashish Srivastava, University Medical Center Groningen
Josue Almansa, University Medical Center Groningen
Regien Biesma, University Medical Center Groningen

Background: Increasing the modern contraceptive prevalence (mCPR) rate in India is considered central to meeting sustainable development goals by 2030. Accredited social health activists (ASHAs) form a cornerstone of the government’s policy to achieve equitable access and increase the mCPR. Despite years of program implementation, however, the national mCPR remains stagnant. This study examined the determinants of modern contraceptive use in India, and the role of ASHAs in shaping this uptake. Methods: The study used data from the 4th wave of the National Family Health Survey (2015-16). Multilevel analysis was used to examine the influence of individual- and contextual-level factors and exposure to ASHA workers on current use of modern contraception. Model progression was designed according to the social-ecological model of health behavior. Results: Prevalence of current modern contraceptive use was 38%. Only 10% of women had any ASHA exposure, with 38% of communities having no women exposed. After adjusting for individual-level characteristics, ASHA exposure had a positive contextual effect on contraceptive use in communities but a negative effect at the individual-level. All the individual, household, and community characteristics, as well as contextual effect of rural residence and community-wealth, were significantly associated with contraceptive use. Conclusion: While the ASHA program has an overall positive effect on contraceptive use in India, this study suggests that not all groups were reached equitably. Moreover, the positive ASHA effect is largely missed due to the low overall exposure of women to ASHAs nationally. More efforts are needed to increase exposure, particularly among marginalized groups.

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 Presented in Session P1. Postercafe