title: Differential effects of community health worker visits across social and economic groups in Uttar Pradesh, India: a link between social inequities and health disparities.
abstract: Uttar 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.
  
  
  
  A 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).
  
  
  
  No 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.
  
  
  
  CHW 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.
authors.affiliation: Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA. aparnas@princeton.edu.
authors.forename: Aparna
authors.initials: A
authors.lastname: Seth
authors.affiliation: Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Tomar
authors.affiliation: Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India.
authors.forename: Kultar
authors.initials: K
authors.lastname: Singh
authors.affiliation: Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India.
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Chandurkar
authors.affiliation: Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Chakraverty
authors.affiliation: Sambodhi Research and Communications Pvt. Ltd., Noida, Uttar Pradesh, India.
authors.forename: Arnab
authors.initials: A
authors.lastname: Dey
authors.affiliation: India Health Action Trust, Lucknow, India.
authors.forename: Arup K
authors.initials: AK
authors.lastname: Das
authors.affiliation: Bill and Melinda Gates Foundation, New Delhi, India.
authors.forename: Katherine
authors.initials: K
authors.lastname: Hay
authors.affiliation: Population Council, New Delhi, India.
authors.forename: Niranjan
authors.initials: N
authors.lastname: Saggurti
authors.affiliation: Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Boyce
authors.affiliation: Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Silverman
mesh_terms: D000293:Adolescent; D000328:Adult; D003150:Community Health Workers; D003267:Contraception; D036861:Delivery, Obstetric; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D006268:Health Facilities; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007194:India; D000067010:Literacy; D008427:Maternal Health Services; D010342:Patient Acceptance of Health Care; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care; D012067:Religion; D012111:Residence Characteristics; D012923:Social Class; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Community health workers; Health inequities; Home visits; Maternal health; Neonatal mortality