Perspective of frontline health workers on the implementation of the PCPNDT Act and Mukhbir Yojana in Jodhpur, Rajasthan: A mixed-methods study

A BSTRACT Background: India continues to struggle with a deep-rooted preference for sons, reflected in the declining sex ratio at birth (SRB). Rajasthan, with a child sex ratio of 883 girls per 1,000 boys, remains one of the worst-affected states. To curb sex-selective practices, the Government of India enacted the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, and the Government of Rajasthan introduced the Mukhbir Yojana in 2015. The frontline health workers (FHWs), including ASHAs and ANMs, are vital for community mobilization, yet their perspectives on these interventions remain understudied. Objectives: To assess the awareness of FHWs regarding the PCPNDT Act and Mukhbir Yojana in Jodhpur, Rajasthan, and to explore challenges faced in their implementation. Methods: A sequential exploratory mixed-methods study was conducted from July–September 2022 across rural and urban Jodhpur. Six focus group discussions and one key informant interview provided qualitative insights, followed by a quantitative survey among 213 randomly selected FHWs. Data were analyzed using thematic analysis and SPSS v23.0, with odds ratios calculated for urban–rural comparisons. Results: Out of the 213 participants, 64.7% were ASHAs and 35.3% were ANMs, with a median age of 38 years. Most (93.8%) were aware of the PCPNDT Act, though only two-thirds had received training. Awareness of the Mukhbir Yojana was significantly lower (50.2%), and just 23% reported departmental training. Urban FHWs had higher odds of training and awareness compared to rural counterparts. Key challenges included discreet sex-selective practices, lack of training, weak law enforcement, and hesitancy of FHWs to act as informers. Despite these barriers, 94.3% expressed willingness to spread awareness about the schemes. Conclusion: FHWs demonstrated strong awareness of the PCPNDT Act but limited knowledge and training regarding the Mukhbir Yojana. Deep-rooted son preference and weak enforcement mechanisms continue to challenge implementation. Strengthening recurrent training, ensuring confidentiality for informers, and fostering community advocacy are critical to curb sex-selective practices.