Implementation of India’s Integrated Child Development Services and maternal and child health practices in a tribal district of Assam: A mixed- methods study

Background India’s Integrated Child Development Services (ICDS) is a nationwide programme designed to improve maternal and child health through supplementary nutrition, growth monitoring, and community-based counseling. Despite programme expansion, disparities persist in tribal regions. This study examines maternal and child health practices among Adivasi communities in Gossaigaon, Assam, and evaluates how frontline implementation of ICDS influences service utilisation and health behaviours. Methods A mixed-methods ethnographic design was employed between July 2023 and December 2025 in villages covered under the Gossaigaon ICDS Project. A household survey was conducted among 127 mothers of children aged 0–6 years to assess antenatal care, place and type of delivery, contraceptive use, and infant feeding practices. Qualitative data were collected through participant observation, semi-structured interviews with 20 Anganwadi Workers (AWWs), ASHAs, ANMs, supervisors, and case documentation. Quantitative data were analysed using descriptive statistics, and qualitative materials were thematically analysed and triangulated across data sources. Results Institutional delivery was widely reported, with the majority of births occurring in government or tea garden health facilities. Early initiation of breastfeeding within 24 hours was observed in 72.9% of recorded cases. Long-acting reversible contraception, particularly intrauterine devices (45.7%), was commonly used, while condom use was absent. Growth monitoring and referral mechanisms enabled identification of malnourished children, although initial resistance to referral was documented. Traditional postpartum dietary practices and herbal applications coexisted with biomedical care. Anganwadi Workers played a critical role in counseling, referral facilitation, and sustaining trust between households and the health system. Conclusions ICDS implementation in this tribal setting is associated with improvements in institutional delivery, early breastfeeding, and contraceptive uptake. However, programme effectiveness depends substantially on frontline relational work and culturally embedded mediation. Strengthening support systems for community health workers, promoting male engagement in reproductive health, and improving referral logistics may enhance sustainability of maternal and child health gains in marginalized regions.