From homebirths to healthier futures: How one Assam district transformed maternal care
ASSAM: Five years ago, South Salmara-Mankachar, a Muslim-majority district on Assam’s Bangladesh border, faced a significant challenge: only 47% of women were delivering in medical facilities. For many, childbirth remained a risky affair at home, far from healthcare assistance.
Today, that figure has surged to 89% and home deliveries have dropped sharply from 5,638 in 2021-22 to just 820 in 2024-25. This dramatic turnaround is a testament to the power of collaboration and community engagement.
A unified approach
The shift in delivery practices reflects a broader improvement in maternal and newborn health. District officials attribute the change to a united effort across various departments, once working in isolation.
The Health Department, in partnership with Education, Social Welfare, and Women & Child Development, combined resources and strategies to improve healthcare access. This collaboration brought health workers, teachers and Anganwadi workers together to engage local communities through village meetings, urging families to choose institutional deliveries.
Strengthening healthcare infra
One of the key interventions was the improvement of local healthcare infrastructure. Ayushman Arogya Mandirs, which offer essential services, were revived with stable electricity connections, ensuring they operated round-the-clock.
Labour rooms were re-equipped and ten new in-house laboratory rooms were set up across the district, bringing diagnostics closer to the people. This reduced one of the main barriers to maternal care in rural areas.
Furthermore, early antenatal care (ANC) saw significant growth. ANC registrations increased from 59% in 2022-23 to 85.3% in 2023-24.
Postnatal care compliance also improved from 63% to 79%, surpassing the state’s average. These advancements in healthcare access have led to better maternal outcomes, including timely risk detection and improved preparedness for delivery.
Role of ASHAs
A crucial part of the success was the role played by Accredited Social Health Activists (ASHAs), who acted as the vital link between expectant mothers and healthcare facilities. ASHAs not only educated women about the benefits of institutional births but also helped them navigate the system, ensuring they received financial support through government programs like Janani Suraksha Yojana.
The shift toward institutional deliveries also streamlined newborn immunization, with more children receiving vaccinations on time due to better tracking and coordinated efforts between health workers and mothers. This has significantly improved child health outcomes, ensuring a healthier future for the community.
Breaking taboos and building trust
Jerifa Khatun, a mother of two from Gazarikandi, shared her experience: “When the health workers came to my home and explained everything, I felt seen for the first time. This time, I chose to deliver at the primary health centre. My baby is healthy and so am I.”
Jerifa’s story echoes across the district. Local leaders, health workers and peer-sharing sessions helped break longstanding taboos about hospital deliveries. The administration also emphasised benefits like on-the-spot birth certificates, which facilitated easier access to government services like school admissions and welfare schemes.
These efforts were crucial in building trust within the community, helping families choose safer birthing options. District Magistrate Rahul Kumar Gupta says the stakeholders worked hard to achieve this success. He says ASHA and Anganwadi workers were motivated by appealing to their sense of community—that they play a key role in ensuring no mother faces preventable risks.
“We highlighted the financial incentives and focused on fast, hassle-free delivery of JSY benefits to mothers, making institutional delivery more attractive,” said DM Gupta, adding, “The district now aims to achieve 100% institutional deliveries and is focused on sustaining this momentum. Efforts are on to strengthen postnatal care and continue community sensitisation.”