9.7 Chapter take-aways

In this chapter we found that ASHAs seem to suggest that women have more autonomy over their decisions than the Mothers seem to think they do. At the very least, the Mothers view certain influencers as gatekeepers (such as mothers-in law and husbands) that constrain their decisions on some key matters. Many of the themes from other chapters are supported here, such as ASHAs having a positive view of their role in the communities, generally feeling respected for their work, and seeing themselves as promoting biomedical behaviors in a fruitful manner. We also see that support from others is key to ASHA success. ASHAs could probably reach out to other ASHAs more often than they do.

Lived experience The ASHA vignettes provided many examples of how the ASHA uses her previous experiences in her service-delivery. For example, ASHAs often reported that they would be honest with Mothers with their own perinatal choices, yet they would not offer this as the only recommendation. Oftentimes, ASHAs acknowledge that many years have passed between their last pregnancy and the current Mothers, so they support the Mothers to do better than they did. Acknowledging their mistakes shows their resilience and personal growth and this honesty could be leveraged when building rapport with Mothers.

Connectedness Most ASHAs report relying on other ASHAs for advice or further discussion when there is a conflict between her own history and the biomedically recommended behavior or if the Mother disagrees with the biomedically recommended behavior. Mothers reported their concerns with certain recommendations, such as IFA tablet consumption, which involved birth defects or miscarriage. Opportunity and training for negotiation and adapting to each mother’s needs is an area of opportunity for efficient and effective service-delivery.

Betweenness ASHAs are definitely embedded in their communities, so much so that the majority of them prioritize their duties as an ASHA over their duties as mothers, requiring them to have a support system at home. This prioritization causes sacrifice on the ASHA’s part, where her children and family may be impacted with consequences (e.g. missing a meal or part of school). ASHA support systems, inside and outside of the home, are crucial to her ability to get her job done. She requires assistance from other ASHAs for job-related queries and assistance from her MIL and other family members to care for her household while she’s away. Further, ASHAs are respected in their community by Mothers and their family members. They reported rare conflicts related to disrespect from Mothers, and the majority reported that they would take help from other ASHA advice.