India's JSY cash transfer program for maternal health: Who participates and who doesn't - a report from Ujjain district

Kristi Sidney,Ayesha De Costa,Ziad El-Khatib,Vishal Diwan

doi:10.1186/1742-4755-9-2

Abstract

BackgroundIndia launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at reducing maternal mortality by promoting institutional delivery in 2005. It provides a cash incentive to women who give birth in public health facilities. This paper studies the extent of program uptake, reasons for participation/non participation, factors associated with non uptake of the program, and the role played by a program volunteer, accredited social health activist (ASHA), among mothers in Ujjain district in Madhya Pradesh, India.MethodsA cross-sectional study was conducted from January to May 2011 among women giving birth in 30 villages in Ujjain district. A semi-structured questionnaire was administered to 418 women who delivered in 2009. Socio-demographic and pregnancy related characteristics, role of the ASHA during delivery, receipt of the incentive, and reasons for place of delivery were collected. Multinomial regression analysis was used to identify predictors for the outcome variables; program delivery, private facility delivery, or a home delivery.ResultsThe majority of deliveries (318/418; 76%) took place within the JSY program; 81% of all mothers below poverty line delivered in the program. Ninety percent of the women had prior knowledge of the program. Most program mothers reported receiving the cash incentive within two weeks of delivery. The ASHA's influence on the mother's decision on where to deliver appeared limited. Women who were uneducated, multiparious or lacked prior knowledge of the JSY program were significantly more likely to deliver at home.ConclusionIn this study, a large proportion of women delivered under the program. Most mothers reporting timely receipt of the cash transfer. Nevertheless, there is still a subset of mothers delivering at home, who do not or cannot access emergency obstetric care under the program and remain at risk of maternal death.

Highlights

India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at reducing maternal mortality by promoting institutional delivery in 2005
All of the programs have experienced increased utilization of maternal health care services [6,7,8], barriers reported from Bangladesh [8,9] and Nepal [10] include issues pertaining to the timely reimbursement of the cash incentive for beneficiaries and providers and difficulties for the most poor women to gain access to the programs
This paper studies the extent of program uptake, reasons for participation/ non participation and factors associated with not participating in the cash transfer program in one district in India

Summary

Introduction

India launched a national conditional cash transfer program, Janani Suraksha Yojana (JSY), aimed at reducing maternal mortality by promoting institutional delivery in 2005. The use of maternal health care services remains low throughout most South Asian countries despite continued efforts to strengthen the infrastructure, drug supply and human resource capabilities [1] While these improvements are important to deliver services, they do not address many of the access barriers faced by the poor [2]. All of the programs have experienced increased utilization of maternal health care services [6,7,8], barriers reported from Bangladesh [8,9] and Nepal [10] include issues pertaining to the timely reimbursement of the cash incentive for beneficiaries and providers and difficulties for the most poor women to gain access to the programs. The ASHA is a female resident of the village who is incentivized to motivate women to deliver at public facilities under the program [13]

Methods

Results

Discussion

Conclusion