**Background:** Accredited Social Health Activist (ASHA) workers serve as a bridge between rural populations and healthcare delivery in India. Despite national health programs, infant mortality rate (IMR) in rural Punjab remains high at 32.4 per 1000 live births compared to 20.1 in urban areas (NFHS V, 2019-2021), and maternal mortality ratio (MMR) is 129 per lakh (SRS 2016-2018). This study aimed to assess ASHA workers' knowledge of maternal and child health (MCH) services and evaluate the impact of their counseling on maternal practices.
**Methods:** This community-based descriptive, cross-sectional study was conducted at RHTC Bhadson, a rural field practice area of Government Medical College, Patiala, from January 1, 2018. From 196 ASHA workers, 72 were selected using simple random sampling (lottery method). Additionally, 100 mothers with children aged 0-6 months were interviewed face-to-face using semi-structured, pretested questionnaires. Sample size was calculated using the formula 4PQ/L² with finite population correction, 95% confidence interval, 10% allowable error, and 10% nonresponse rate. Data were analyzed using Epi Info 7 with descriptive and inferential statistics; Pearson Chi-square test was used for associations.
**Key Results:** Among ASHA workers, 65.2% were above 35 years of age, 56.9% were matriculate pass, and 38% belonged to middle socioeconomic status. Regarding antenatal knowledge: 83.33% knew pregnancy confirmation by Nishchay Kit; 55.55% correctly identified average weight gain in pregnancy as 10 kg; 41.66% knew IFA tablets should be taken 6 months before and after delivery. However, only 2.77% correctly identified the hemoglobin cutoff for anemia diagnosis in pregnancy (<11 g/dl). For postnatal care: 59.72% correctly stated seven postnatal home visits for institutional deliveries; 63.88% identified all listed pregnancy complications. For newborn care: only 23.6% knew breastfeeding should be initiated within the first hour after delivery; 2.77% correctly identified low birth weight as <2.5 kg; 51.38% said first bath should be given after the second day. Counseling coverage among mothers: institutional delivery (85%), birth registration (81%), exclusive breastfeeding (79%), nutrition (76%), birth preparedness (77%), keeping baby warm (77%), immunization (90%), but low for cord care (22%), eye care (17%), and danger signs in pregnancy (29%). Statistically significant associations were found between counseling and practices: early bathing (χ²=33.41, P<0.001), pre-lacteal feeding (χ²=21.8, P<0.001), family planning use (χ²=74.05, P<0.001), and exclusive breastfeeding (χ²=13.617, P<0.001). Early initiation of breastfeeding showed no significant association (χ²=0.348, P=0.55).
**Clinical Implications:** The study identifies critical knowledge gaps among ASHA workers, particularly in postnatal and newborn care, which directly affects the quality of community-level MCH services. The significant impact of counseling on key maternal practices (pre-lacteal feeding, family planning, early bathing, exclusive breastfeeding) demonstrates the potential of ASHA workers to improve health outcomes when properly trained. The findings underscore the urgent need for targeted refresher training focusing on newborn care (breastfeeding initiation timing, low birth weight identification, cord and eye care) and postnatal monitoring. Routine monitoring of ASHA service quality at scale is recommended to ensure consistent, high-quality community health delivery in rural India.