Abstract
BackgroundIn 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services.ObjectiveTo assess the effect of maternal receipt of financial assistance from JSY on childhood immunizations, post-partum care, breastfeeding practices, and care-seeking behaviors.MethodsWe use data from the latest district-level household survey (2007–2008) to conduct a propensity score matching analysis with logistic regression. We conduct the analyses at the national level as well as separately across groups of states classified as high-focus and non-high-focus. We carry out several sensitivity analyses including a subgroup analysis stratified by possession of an immunization card.ResultsReceipt of financial assistance from JSY led to an increase in immunization rates ranging from 3.1 (95%CI 2.2–4.0) percentage points for one dose of polio vaccine to 9.1 (95%CI 7.5–10.7) percentage points in the proportion of fully vaccinated children. Our findings also indicate JSY led to increased post-partum check-up rates and healthy early breastfeeding practices around the time of childbirth. No effect of JSY was found on exclusive breastfeeding practices and care-seeking behaviors. Effect sizes were consistently larger in states identified as being a key focus for the program. In an analysis stratified by possession of an immunization card, there was little to no effect of JSY among those with vaccination cards, while the effect size was much larger than the base case results for those missing vaccination cards, across nearly all immunization outcomes.ConclusionsEarly results suggest the JSY program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review. Causal interpretation of our results relies on the assumption that propensity scores balance unobservable characteristics.
Highlights
India has some of the worst maternal and child health indicators in the world, with approximately 18% of global maternal deaths and over 20% of all deaths among children under age five years.[1,2] From 2000 to 2008, India experienced an average annual decline in under-five mortality rate of 3.9%, with highly uneven progress across states, and falling short of the 4.4% reduction per year required to meet the 2015 Millennium Development Goal (MDG) 4 target.[3,4,5] Since 2008, India has experienced a higher rate of decline in under-five mortality,[6] some of which may be attributed to the launch of the national rural health mission in 2005
Early results suggest the Janani Suraksha Yojana (JSY) program led to a significant increase in childhood immunization rates and some healthy reproductive health behaviors, but the structuring of financial incentives to pregnant women and health workers warrants further review
This study evaluates the impact of JSY on childhood immunization rates in India
Summary
India has some of the worst maternal and child health indicators in the world, with approximately 18% of global maternal deaths and over 20% of all deaths among children under age five years.[1,2] From 2000 to 2008, India experienced an average annual decline in under-five mortality rate of 3.9%, with highly uneven progress across states, and falling short of the 4.4% reduction per year required to meet the 2015 Millennium Development Goal (MDG) 4 target.[3,4,5] Since 2008, India has experienced a higher rate of decline in under-five mortality,[6] some of which may be attributed to the launch of the national rural health mission in 2005. According to the World Health Organization (WHO), approximately 40% of all under-vaccinated children, defined as children who did not receive 3 doses of diphtheria, tetanus and pertussis (DPT) in their first year of life, live in India.[7] immunization rates have increased over time, only slightly more than half of children nationwide are fully vaccinated, with wide variations across geographic and socioeconomic strata.[8] Inadequate rates of childhood immunization persist despite vaccinations being provided free of charge in public health facilities through India’s Universal Immunization Program (UIP), which covers 27 million infants and 30 million pregnant women annually.[9,10]. In 2005, India established a conditional cash transfer program called Janani Suraksha Yojana (JSY), to increase institutional delivery and encourage the use of reproductive and child health-related services
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