Saas, bahu, and ASHA: Information diffusion and behavioural change in rural Bihar

  • Bihar has a persistently poor record concerning Maternal and Child Health (MCH) targets.
  • The National Health Mission and Health and Nutrition Strategy of JEEViKA, Government of Bihar, have attempted to improve MCH outcomes by increasing awareness of desired targets.
  • Our study shows that Accredited Social Health Activist (ASHA) workers have enhanced awareness of MCH issues, leading to substantial behavioural change. This has led to an improvement in MCH outcomes in Bihar.
  • The ASHA workers have been most successful in generating effective outcomes among less educated women from poor households, and among disadvantaged groups (Scheduled Castes and Other Backward Castes). Their outreach activities among more educated women from affluent households are limited.
  • We found that family members, particularly mothers-in-law (saas), mediated the interaction between ASHAs and women of childbearing age. The former is, thus, able to control the flow of information from the ASHA to target women and facilitate or obstruct the process of adoption of desirable reproductive and dietary practices.