Lived experiences in action: Relations between community health workers' and clients' perinatal health behaviours in India

Community health workers are crucial bridges between health systems and local populations, uniquely positioned at the intersection of personal experiences and professional duties. Yet, limited research examines how these workers' personal health decisions influence their clients' behaviours. This study addresses this gap by investigating associations between the maternal experiences of Accredited Social Health Activists (ASHAs) and perinatal health practices among their clients (recent mothers) in Bihar, India. Using a large-scale cross-sectional survey involving 400 ASHAs and 1166 clients, we conducted mixed-effects logistic regression analyses to examine these relationships. Our findings reveal a strong association between ASHAs' personal practices and their clients' behaviours during pregnancy. ASHAs who adhered to evidence-based health practices recommended by formal healthcare systems, such as early pregnancy registrations and antenatal check-ups, and those who engaged in traditional practices, such as concealing pregnancy or calling traditional midwives during labour, predicted similar practices among their clients. These results highlight the critical position of community health workers at the intersection of personal and professional spheres, where their lived experiences meaningfully influence their work. Public health systems should leverage community health workers' shared sociocultural and personal experiences through targeted training, supporting their role in fostering sustainable maternal and child health improvement.