One of India’s greatest strengths in community outreach in healthcare is the vast network of Accredited Social Health Activists (ASHA), which stands at 1.03 million as of September 2024, and contributes to the largest volunteer health workforce in the world. As a trusted community health worker selected from within the community, she is vital in enhancing healthcare utilization and coverage under the National Health Mission (NHM). A macro level population study found that there has been an increase of 17% in women receiving at least one ANC visit, 5% in four ANC visits, 26% in deliveries attended by skilled birth attendants, and 28% in facility-based deliveries with the intervention of ASHA in India.
A well-equipped and wellsupported ASHA is bound to improve the maternal health, nutrition, immunization, and other community health outcomes through strategic interventions in different regions. The community outreach activities by ASHA, coupled with other significant health provision measures, have contributed significantly to a 61.8% reduction in Maternal Mortality Rate(254 to 97) from National Family Health Survey -3 (2005-06) to National Family Health Survey -5 (2019-21). Although Rs 24,994.45 million (India) and Rs 414.791 million (Haryana) were expended for ASHAs in FY 2024–25, the overall spending as per National Health Mission fell over 20% since 2019–20, reflecting reduced focus and shift in priorities for advancement of ASHA.
Ironically, postnatal care remains an overlooked agenda, failing data capturing on four prescribed postnatal visits by WHO, UNICEF, NFHS, and DHS etc. Despite the consistent efforts by ASHA by visiting door-to-door,the postnatal care utilization lags behind other maternal and child health services. Globally, about 30% of women and newborns did not receive postnatal care (WHO, 2022). As noted by the authors in district Faridabad, Haryana, 84.3% of JSY beneficiaries received a visit by ASHA within seven days of childbirth, and 66.8% got postnatal counselling, but only around one-fifth (21.3%) of Janani Suraksha Yojana (JSY)beneficiaries were accompanied for all four recommended postnatal check-ups. An ASHA from the district Faridabad highlighted the logistical and emotional strain of accompanying mothers for postnatal care.
She exclaimed, “During postnatal checkups, many mothers resist weighing their babies, fearing the hanging scales are unsafe. They feel the sling offers poor neck support and is disrespectful to the dignity of newborns.” Such experiences greatly influence the perception of quality of care provided by the health centre, and often discourage mothers from seeking immediate next postnatal check-ups. In rural India, deep-rooted traditions discourage taking newborns outside for a month, delaying timely postnatal care. Many JSY beneficiaries echoed these beliefs, meant to protect infants from illness or the “evil eye.” An ANM reported women carrying knives during delivery to ward off negative energies. Such customs often become barriers to care.
The scarcity of basic postnatal supplements, especially calcium tablets, at public health centres further demotivates women, and they refrain from visiting the health centre. Some JSY beneficiaries acclaimed; “Why should we walk all the way to the health centre with a small baby, troubling our ASHA didi, if the medicines we need aren’t even available there? After such a long and tiring walk, getting something as basic as calcium should at least feel rewarding.” Many times, mothers-inlaw, who are often culturally aware and familiar with the system, discourage postnatal check-ups—not out of tradition, but due to perceived systemic inefficacy. AnASHA recalled being told by many mother- in-laws; “She’s doing fine. We know there won’t be medicines at health centre – just consultation. You have other homes to visit; don’t waste your time here.”
This reflects a growing perception among rural women that routine postnatal care has little value unless a clear problem exists, especially amid service gaps. Postnatal care is influenced by delivery location, staff behavior, and trust in home care. This study found that although 97.9% women received ASHA home visits, only 18.7% were accompanied to health centres for PNC checkups. ASHA satisfaction also dropped with indifferent behaviour of paramedical staff which affected PNC utilization. Many women prefer home recovery, citing better family support and poor facility conditions, as one JSY beneficiary praised traditional care by her mother-in-law; “Why should we visit the health center when the ANMs are impolite, the equipment doesn’t work, and there’s no proper sanitation? Our mother-in-laws offer better care.”
These gaps highlight the need for respectful treatment, functional infrastructure, and stronger follow-up to improve institutional postnatal care uptake.The fact can not be refuted that postnatal care is an important aspect and in order to improve postnatal care, strengthening ASHA support through regular training, supervision, and better incentives is essential to overcome cultural resistance, enhance PNC followups, and boost community trust. The institutional and social support to ASHA can significantly improve outcomes, but they cannot compensate for public health systemic inefficiencies. Training ASHAs, elderly women, and local influencers in localized IEC (Information, Education and Communication) campaigns can help reduce harmful cultural practices like newborn isolation and delivery rituals.
An improvement in facilitybased care, especially better sanitation, respectful treatment, privacy, and functionality ofequipment—would encourage women to seek institutional PNC. Further, providing essential supplements like calcium and mother-friendly newborn weighing tools can motivate mothersand build trust in the public health delivery system. Bridging public-private referral gaps with structured linkages and counselling protocols is needed to ensure continuity of care.Targeted orientation for influential family members, such as mothers-in-law, can turn skeptics into allies for institutional postnatal care. If India is truly committed to maternal and child health, it must equally invest in the wellbeing of its frontline workers by ensuring institutional support, dignified work environments, timely payments, and modern tools. ASHAs are the foot soldiers of India’s public health system, yet too often they are asked to march without proper equipment and provide services to the rural populace.
For real reform, India must devise re-engineered fieldto-institution strategies to confront systemic blockages and postnatal service inconsistencies, ensuring that the burden of failure does not fall unfairly on the shoulders of ASHA workers. [The article is an output from the seed money project, “An Assessment of PostNatal Maternal Healthcare Under Janani Suraksha Yojana (JSY) in Faridabad, Haryana”, sanctioned by Manav Rachna International Institute of Research and Studies.] Dr. Vijayetta Sharma is Associate Professor of Public Policy at Manav Rachna International Institute of Research and Studies. Dr. Anandajit Goswami is Professor, Director, School of Behavioural and Social Sciences, and Research Director at Manav Rachna International Institute of Research and Studies.
