Asha workers’ ‘tireless efforts’ help cut maternal deaths by half in 2022

Despite poor roads and heavy rains, Nandita, undeterred, organised transporting the pregnant woman on a cot to the ambulance, reaching the block hospital 20 kms away. Apart from Jyoti, Nandita also saved the life of her baby in August last year.

“We receive emergency calls at all hours, even in the middle of the night when my husband has to accompany me,” Nandita said. The relentless efforts of Accredited Social Health Activists (ASHAs) like Nandita, integral members of the state’s 70,000-strong female healthcare frontline, have significantly contributed towards drastically reducing maternal deaths in Maharashtra.

Data collected by The Indian Express from the state health department showed that in a significant development, maternal deaths—a major health indicator—have decreased by 50 percent, from 459 in 2021 to 227 in 2022 in Maharashtra, one of the lowest marks recorded in the state in the last decade.

In 2017, 2018 and 2019 the state recorded 319, 380 and 498 maternal deaths respectively. Amid the pandemic in 2020, the state recorded 466 fatalities.

Maternal death refers to the death of a woman during pregnancy, childbirth, or within 42 days of delivery or termination of pregnancy.

In 2022, the Central government also acknowledged Maharashtra’s commendable efforts in reducing maternal mortality rates from 38 deaths per one lakh live births to 33 per lakh live births. The state ranks second, following Kerala, in recording the lowest maternal deaths in India.

“Through their unwavering commitment and tireless efforts, ASHA workers have significantly contributed to reducing maternal deaths. Their diligent work in educating, supporting, and ensuring proper healthcare for pregnant women has played a pivotal role in improving maternal health outcomes, fostering institutional deliveries, and ultimately contributing in lowering mortality rates,” said Maharashtra’s additional chief secretary of the public health department Milind Mhaiskar.

Statewide, Asha workers have received training from the government and NGOs to identify health issues post-delivery or during deliveries. This has been particularly crucial in tribal-dominated areas like Gadchiroli.

Dr Vinod Mhashakhetri, Additional District Health Officer in Gadchiroli, explained the insufficient practical knowledge of Asha workers, leading to delayed identification of mothers with health complications and subsequent deaths. Despite being equipped with health kits that have diagnostic tools, Asha workers were not proficient to use them.

“In response, the district health department, through the Palavi project, prioritised training over 2,000 Asha workers in the early detection of mothers and infants requiring immediate medical attention, with a primary focus on those delivered at home,” he said.

ASHA workers conduct home visits to educate and support pregnant women. They ensure women receive timely and regular antenatal check-ups, promoting a healthy pregnancy. They are the first line of contact for dispelling myths about pregnancies.

“The tribal communities, to a great extent, are dependent on alternative medicines and refuse to take essential antenatal medicines like vitamins and folic acid. So, we have to counsel them through picture books. During visits, we check the tablets to ensure they are consuming them,” said Kavita Bhoyar from Palghar.

Dealing with misinformation about the gender of the child is another significant hurdle they face on a daily basis. Priya Dhurve from Nandurbar shared her experience of how pregnant women are being mistreated by in-laws if they have more than two daughters for not delivering sons. Some even fall victim to domestic violence during pregnancy.

“Then we inform the local panchayat or NGOs to intervene, as in most cases, the women don’t want to approach the police. But sometimes, we do have to seek help from the police,” she said.

In cases of repeated pregnancies, the ASHA workers also have to counsel the husbands who often become abusive. In many cases, the women workers are even shunned by the in-laws. Therefore, the they accompany their husbands or brothers for their protection.

“Most women in rural zones are anaemic. They don’t even get adequate nutrition during pregnancy, and are forced to give birth 10-14 times. Many children don’t even survive, and the mothers become so weak that they look like skeletons,” said Anagha Pawar, an anganwadi worker from Beed.

These foot soldiers also take the responsibility of enlisting pregnant women in different available schemes like Pradhan Mantri Matru Vandana Yojana (PMMVY), Janani Suraksha Yojana, among others. “I would watch food videos to teach pregnant women how to cook healthy, protein-rich foods from garden vegetables or more affordable ingredients,” said Sneha Pendamm, an anganwadi worker from Nanded who keeps sharing the recipes in her WhatsApp status.

Last year, the World Health Organization recognised ASHAs with the Global Health Leader award for their efforts in addressing Covid-19 and significantly reducing India’s maternal mortality rate.