JOB MARKET PAPER: Can Community Health Workers Affect Reproductive Health Decisions? Evidence from India

Abstract

Do supply-side interventions change individual behaviors? This paper examines the effect of India’s Accredited Social Health Activists (ASHAs) on long-term reproductive health. I use large-scale survey and administrative data and exploit the variation in the number of ASHAs along with variations in the birth year, employing a difference-in-differences design. I find that the policy made women better off in terms of utilizing various reproductive healthcare services, such as antenatal care and institutional deliveries, along with an increase in contraceptive use in the long term. I find that an additional ASHA per 1,000 population is associated with a 2.14 to 5.2 percent increase in the utilization of reproductive health. This result is robust to an alternative specification with district-level ASHA utilization as the treatment. Results are heterogeneous across groups, with contraceptive use being driven by women who are richer, literate, and have less than three children during their peak reproductive ages. I find that ASHAs are associated with higher contraceptive use only in districts where utilizing the ASHA service is below the sample median, suggesting that performance incentives for the provision of family planning methods should be revised to meet the aim of lower fertility.