The long road to health: Healthcare utilization impacts of a road pavement policy in rural India

Abstract

Despite demand-stimulation efforts, coverage rates of many essential health services remain low in developing countries, suggesting that there may be binding supply constraints, such as poor access to healthcare facilities. This paper utilizes quasi-random variation in road-pavement intensity to study the impact of improved access on adoption of reproductive health services. I find that road construction led to more institutional antenatal visits and deliveries, which translated into better medical care and vaccination coverage, with larger gains for girls. Better ante-natal care resulted in fewer miscarriages, although much of this decline is due to delayed, rather than averted mortality as infant mortality went up. Overall mortality, including in-utero, stillbirths, and during infancy, is unimpacted. Most gains in natal and ante-natal care accrue from repeat visits by existing patients, and some from new entrants into the formal health sector. Evidence suggests that beneficiaries travel farther to see better providers.