Si Ting Chen

I have never been more aware of my gender than when I was in Delhi. Covering my arms and legs for modesty, getting swindled by rickshaw drivers and walking through separate lines for all forms of security marked just a few of the daily encounters that reminded me of my womanhood and what that meant in a highly-gendered culture. (But I must admit, I did love riding in the women’s only metro car at the front of the train.)

Many factors challenge women’s health and gender equality in India, from underrepresentation in education and the workforce to gender-based violence. In 2023, 32.7 percent of women participated in the labor force in comparison to 76.8 percent of men. Additionally,  27.3 percent of women ages 20-24 were married before the age of 18, 18.4 percent of women reported subjection to physical and/or sexual violence from their partner in the last 12 months and 86 percent of women who faced gender-based violence never sought help.

Yet, women are the foundation of India’s healthcare system.

The Accredited Social Health Activist (ASHA) program was implemented as part of India’s National Rural Health Mission in 2006 and expanded to the whole country in 2009 to increase access to health services in rural and low-income urban communities.

ASHAs are incentive-based volunteers dedicated to providing door-to-door health services. ASHAs are women elected by their local government who serve 1,000 people in their villages, visiting 10–15 houses daily to give check-ups and monitor symptoms in the community along with all the pregnancies and births. While the ASHA program initially targeted maternal and child health, ASHAs are now health heroes for those of all backgrounds.

“An ASHA has 65 jobs in one,” a nurse at the Gogunda Community Health Center in Udaipur said.

Sixty-five jobs may even be an understatement of an ASHA’s daily responsibilities. Along with the help of a government nurse called an auxiliary nurse midwife, ASHAs register all pregnant women into the local healthcare system; immunize all children ages 0–18; refer patients to doctors and nurses; oversee tuberculosis and leprosy screening programs; monitor and supervise tuberculosis medication regimen; identify people below the poverty line for government resources; inform people of proper health and diet habits; check the blood pressure, blood sugar and thyroid levels of all elderly people; discuss family planning and contraception options for women; clear stagnant water and welcome new families into the community. If those tasks weren’t enough, ASHAs also add all the patient data they collect to apps that allow the government to track health outcomes across the entire population.

ASHAs offer invaluable services to their communities but receive extremely low compensation for the work that they do. However, when asked why they chose to be an ASHA, all of the ASHAs I met remarked that their love for helping members of their community motivates them, even on the most challenging days.

“When I saw the work of the ASHA, I saw how much I could do for the community and how I could make a few lives better with the limited capacity that I have,” an ASHA at the Loyara Sub Center in Udaipur said.

The charm of the ASHA approach is that the volunteers are members who were married—and often grew up—in the community. For this reason, ASHAs gain their patients’ trust and exhibit substantial impacts on health simply by building strong personal relationships with their patients.

ASHAs were first implemented in rural areas to improve maternal mortality rates and increase public trust in government health facilities, but the program expanded to address a need for better health access in low-income urban neighborhoods and informal settlements.

“I saw that mothers in the hospital are helpless. Children don’t have vaccinations. There’s a need for healthcare in urban underprivileged areas,” the ASHA for the Priyanka informal settlement in Delhi said.

Especially in urban areas with greater access to healthcare facilities, ASHAs bolster women’s health by guiding mothers through pregnancy and offering both nutritional and educational support to women postpartum.

“As a woman working in the community, working for women in the community is a big deal,” the ASHA for Priyanka said.

Beyond the health services they provide, ASHAs are role models for women in their communities, hopefully inspiring the next generation to grow up and make a positive impact.

In a country where I often felt patronized for my gender, I also felt empowered by the ASHAs who uplift their communities, despite the challenges they face. While I can’t take the ASHA system back to America, I can adopt ASHAs wisdom and passion for community care and use it as fuel for change.