Janani Suraksha Yojana Research Articles

Utilization of antenatal services by JSY beneficiaries in rural area of Pune district of Maharashtra

Background: To combat the reproductive and child health (RCH) problems, National Rural Health Mission (NRHM) had launched Janani Suraksha Yojana (JSY) in April 2005 in all states and union territories to promote institutional deliveries among the poor population through provision of antenatal, intra-natal and post-natal care services for women to have healthy outcomes of pregnancy and child birth. Hence this study has been undertaken on one of the important aspect of services that is antenatal care services with the objective to assess the utilization of antenatal care services among JSY beneficiaries in rural area.Methods: Cross sectional observational study done in the area under rural health training centre of a private medical college of Pune district. 1st October 2014 to 30th September 2015. Study sample: All JSY beneficiaries who delivered during study period (1st October 2014 to 30th September 2015). One to one interview with the all 155 beneficiaries was conducted using the pretested, questionnaire. The interview was timed at minimum 6 week interval after the delivery. Data analysis was done by using SPSS 20.0 statistical software.Results: Majority 78 (50.3%) of beneficiaries out of 155 got registered themselves within 12 weeks of pregnancy. Antenatal coverage was quite good. Coverage of injection tetanus toxoid was 100% and all essential investigation have been carried out. Association between literacy level (up to higher secondary level) of beneficiaries and number of ANC visits was found statistically significant (p<0.001).Conclusions: In present study utilization of ANC services was found to be good.

Inequalities in the utilization of maternal health care in the pre- and post-National Health Mission periods in India.

Since the implementation of the National Health Mission (NHM) in India there has been a noticeable improvement in the utilization of maternal care, namely antenatal care (ANC), skilled birth attendants (SBA) and postnatal care (PNC) in the country. The increase in utilization of these services is expected to reduce inequality across geographies and population sub-groups, but little is known about the extent of inequality in maternal care use across socioeconomic groups over time. Using data from the last two rounds of National Family Health Surveys conducted in 2005-06 and 2015-16, this study examined the extent of inequality in utilization of full ANC, SBA and PNC in India and its states. Descriptive statistics were used, a concentration index was computed and decomposition analyses performed to understand the pattern and change of inequality in use of maternal care. The results suggest that the gap in maternal care utilization across socioeconomic groups has reduced over time. The concentration index for SBA showed a decline from 0.49 in 2005-06 to 0.08 by 2015-16, while that of PNC declined from 0.36 to 0.13 over the same period. The reduction in inequality in utilization of full PNC was the least. The results of the decomposition analysis revealed that urban residence, education and belonging to Scheduled Caste and Scheduled Tribes positively contributed to the inequality. Based on these findings, it is suggested that the Janani Suraksha Yojana and Janani Sishu Suraksha Karyakaram schemes be continued and strengthened for poor mothers to reduce maternal health inequality, particularly in full ANC and PNC.

The price of a woman: Re-examining the use of financial incentives for women’s health in India

ABSTRACTThe use of financial incentives is a common instrument to advance women’s health across low and middle-income countries. Since the 1990s, the conditional cash transfer (CCT) for health has been generally lauded by researchers, policy makers and international financial institutions due to demonstrated improvements in access to health services and a range of health outcomes. Some scholars, however, have cautioned that CCTs should be further scrutinised to assess potential unintended consequences and moral concerns in a variety of contexts. In this article, I re-examine Janani Suraksha Yojana (JSY), a cash incentive programme that aims to promote institutional deliveries in order to reduce high levels of home deliveries and maternal deaths in India. I adopt a critical perspective, focusing on the specific instrument of dowry through the lens of capitalist patriarchy (Mies, M. (1986). Patriarchy and accumulation on a world scale. London: Zed Books). Global and national health policy experts and policy makers require a greater awareness of the dowry system, since this system may hamper the use of financial incentives by reinforcing the commodification of women.

Regular Antenatal Care Visits Predict Good Knowledge Among Post-natal Mothers Regarding Entitlements of Health Programs in Western India.

Janani-Shishu Suraksha Karyakram (JSSK) and Janani Suraksha Yojana (JSY) were launched with the objective of increasing institutional deliveries. But, its knowledge among the post-natal mothers is not known. This research evaluated the knowledge of two national health programs among post-natal mothers and found out the predictors of good knowledge about the entitlements of these programs. A cross-sectional study was conducted on a sample of consecutively recruited 339 post-natal mothers who had delivered in a tertiary care hospital of western India. Data were collected from November 2016 to February 2017 by interview method using a questionnaire with questions about knowledge regarding the entitlements of JSSK and JSY. Multivariable analysis was carried out for predictors of good knowledge. Among the 339 post-natal mothers, 30% had a good knowledge regarding JSSK. Only 24% had heard about JSSK; 54% knew regarding free transport to the place of delivery; only 22% and 13%, respectively knew about free inter-facility transport in case of complications for pregnant women and sick infants, while 96% knew regarding free drop-back facility. Only one-fourth of the mothers knew regarding monetary benefit under JSY, while 28% of them had actually received the benefit. The number of antenatal care visits, having an occupation and belonging to Hindu religion significantly predicts good knowledge among postnatal mothers regarding JSSK. Knowledge among the post-natal mothers regarding the entitlements of JSSK and JSY is less while comparing with published literature and needs improvement. Regular ante-natal care (ANC) visits might improve their knowledge of these programs. There is a need to create awareness among hospital staff for the provision of reimbursement of costs incurred by post-natal mothers. There is also a need to carry out demand generation activities among mothers regarding the entitlements of JSSK and JSY.

Does Shorter Postnatal Hospital Stay Lead to Postdischarge Complications? An Instrumental Variables Approach

AbstractWe exploit the difference in means of postnatal hospital stays between beneficiary mothers of Janani Suraksha Yojana (JSY) and control mothers to estimate causal effects of postnatal hospital stay on postdischarge complications of a mother and her newborn. We argue that JSY increases the demand for institutional deliveries in those hospitals, which are assigned by the government to provide such services to the JSY recipients. Given the limited supply of beds, health professionals and other facilities, an excess demand for institutional deliveries in those hospitals forces JSY recipients to stay for a shorter time after birth compared with nonrecipients of JSY who are free to deliver in any hospital. Thus, the dummy for JSY becomes a suitable instrument for postnatal hospital stay. Using instrumental variables (IV) regressions, we find that postnatal hospital stay has statistically significant negative causal effects on half of the available postdischarge complications in the data, including abdominal pain, vaginal discharge, convulsion and severe headache of a mother and fever or cold of the newborn. © 2019 John Wiley & Sons, Ltd.

Does the National Rural Health Mission improve the health of tribal women? Perspectives of husbands in Maharashtra, India

ObjectivesThis study examined the health status of tribal women and, in particular, their maternal health. This study also explored the utilization of the Janani Suraksha Yojana (JSY) scheme, the tribal motherhood scheme and the human development scheme among pregnant women. The performance of accredited social health activist (ASHA) workers was also investigated. To fulfil the study objectives, husbands and key informants were interviewed. Study designThis was a cross-sectional, community-based study. MethodsBoth qualitative and quantitative methods were used for data collection. For the quantitative analysis, 385 men, aged 15–49 years, whose wives had given birth in the last 2 years, were recruited using multistage sampling. To study the qualitative aspects of the maternal health situation, 15 interviews were conducted with key informants, and four focus group discussions were conducted with a mixed-age group of men. The key informants included the dais (midwives/traditional birth attendants) and ASHAs in the villages studied. ResultsThe results revealed that less than half of women delivered in health facilities, but nearly 60% of births were attended by skilled medical personnel. The utilization rates for full antenatal care (ANC) and postnatal care were 70% and 50%, respectively. Nearly 60% of men had heard about the JSY scheme; however, only 57% reported that their wives had benefited from the JSY scheme. The mean amount of money received was ₹700 ($US 11) for the most recent birth. For men whose wives did not receive the benefits of JSY, 24% reported that their wives were not eligible for the scheme, and the majority (75%) reported that they were not aware of the JSY scheme. ConclusionsThe basic community-level issues of limited medical workforce and medical equipment should be urgently addressed. Moreover, full ANC and institutional health facilities for delivery should be provided to tribal women. When implementing National Rural Health Mission strategies, understanding the local community-driven traditional and cultural factors is important.

Direct and Indirect Effects of Janani Suraksha Yojana on Antenatal Care and Institutional Delivery

Janani Suraksha Yojana (JSY) provides conditional cash incentives to eligible pregnant women in India so that they can take at least three antenatal care services including tetanus injection and iron-folic acid, to deliver their babies in health institutions, and to take at least one postnatal service for them and their neonatal babies. We examine its effects on antenatal care and the institutional delivery. We also decompose effects into direct and indirect categories, deriving parameters from the theoretical model, then estimating them using several regression methods including the propensity score matching. We use the fourth round of the District Level Household Survey (DLHS), which has an advantage over the previous waves of DLHS.

Determinants of Choice of Care Providers During Childbirth in Rural West Bengal, India

The article analyses determinants of choice of care providers during childbirth. Public health facilities provide care for free to all women during childbirth in West Bengal. In addition, a cash incentive is also attached with the service package for poor women who give birth at public health facilities. However, a section of women still prefer to give birth at home and some avail services from private facilities. The article attempts to explore the reasons underlying such difference. This analysis is based on primary data collected from four villages of Jalpaiguri district following multistage sampling method. It involved a survey of 251 households having at least one child below 2 years. Multinomial logistic regression model was used to analyse the data. The results suggest that quality of public health services, rural infrastructure, utilization of antenatal care and conditional cash transfers influenced the choice of care providers. Women who were eligible for and were aware of Janani Suraksha Yojana were less likely to go to private health facilities for childbirth. However, the programme did not seem to be effective in terms of reducing delivery at home.

Awareness and effect of Janani Suraksha Yojana on antenatal care and institutional deliveries in rural, urban & tribal areas of Ahmednagar district

Janani Suraksha Yojana (JSY) is a centrally sponsored scheme which is being implemented with the objective of reducing maternal and infant mortality by promoting institutional delivery among pregnant women. The Government of India introduced the JSY (safe motherhood program) based on the principles of CCT. Under JSY, cash assistance was given to pregnant women receiving at least three antenatal check-ups (ANCs) and delivering at institutions. The study is undertaken to establish if there is any co-relation of level of awareness about the scheme and its impact on ANC and institutional deliveries in the rural, urban and tribal area of Ahmednagar district. Method: The JSY beneficiaries were asked demographic characteristics, area of residency, educational levels, Category and place of delivery were noted. A set of question (self-designed and pretested) and their responses were noted. Result: Out of 825 JSY beneficiaries, there were total 781 (94.7%) Hindu, Muslim 23(2.8%) and Christian 21 (2.5%) beneficiaries. Majority of Hindu religion JSY beneficiaries. Only few member from BPL JSY beneficiaries have opted for delivery at private hospital. Maximum deliveries taking place in civil hospital are from BPL category. It was observed that the awareness level about JSY is low in tribal area compared to the rural and urban area. It was also seen that 648 (78.54%) JSY beneficiaries availed free transport facility out of which 358 (55.24%) fall in high level of awareness category. There is a positive relation between age group and awareness about JSY. Conclusion: 46.8% women with high awareness about JSY scheme, it is a programme for pregnant women which aims at safe institutional delivery. Other factors such as education of mother, religion, culture, area of residence, family type played important role in utilization of available maternal health scheme.

Janani Suraksha Yojana - cash assistance scheme for maternal and child health: Retrospective analysis of acceptance of postpartum intrauterine contraceptive device insertion among its beneficiaries

Background: Janani Suraksha Yojana (JSY) was launched on April 12, 2005, under the National Health Mission for the benefit of maternal and child health. JSY is a centrally sponsored scheme, which integrates cash assistance with delivery and post-delivery care. Just after delivery, women are more receptive to accept a contraceptive method. With increased institutional deliveries influenced by JSY, the health-care providers have an excellent opportunity to counsel and provide them with safe and appropriate contraceptive method. The Government of India launched postpartum intrauterine contraceptive device (PPIUCD) services in the year 2000; although acceptance of PPIUCD in JSY beneficiaries is a real concern. Objectives: The objectives of this study were as follows: (1) To study the acceptance of PPIUCD in JSY beneficiaries and (2) to study the sociodemographic factors in relation to PPIUCD acceptance. Materials and Methods: The retrospective study was conducted in Rural Government Hospital in Maharashtra during 2016–2017. We studied sociodemographic variables of JSY beneficiaries and their acceptance to PPIUCD. The sample size was 353 (n = 353). The sociodemographic factors studied included age, type of delivery, sex of newborn, and educational status of patient and her husband. Results: The total postpartum women included in the study were 353 who had taken JSY benefit, of which, 116 (32.6%) accepted for PPIUCD, whereas 237 (67.4%) rejected the same. Around 43% of primipara patients were accepted PPIUCD. Among multiparous women with three living children, only 6% accepted it. The educational status of both, the postpartum women and their husband, showed statistically significant association with the acceptance of PPIUCD (P < 0.05) in JSY beneficiaries. Conclusions: The acceptance PPIUCD was low (32.6%) in JSY beneficiaries. Primipara or young age patients are easy to counsel about PPIUCD, and hence, the acceptance is high. All efforts should be made to increase acceptance of PPIUCD among JSY beneficiaries.

Utilisation of Janani Suraksha Yojana among Women in Urban and Rural Areas of Western Uttar Pradesh

Utilisation of Janani Suraksha Yojana among Women in Urban and Rural Areas of Western Uttar Pradesh

Infection control practices at facilities providing monetary incentives for facility births: An assessment at selected labour and delivery rooms in two states of India

Introduction: We report findings from an assessment of infection prevention and control (IPC) practices using a standardised assessment tool at five facilities in high maternal mortality areas of India. Methods: This study was conducted in five public facilities in the two high-focus states ‒ Odisha and Rajasthan. Both the states registered a high uptake of the Janani Suraksha Yojana programme. We surveyed facilities using the infection control assessment tool. The overall quality of those practices assessed in each section was as follows: A – excellent practices in this area (75%–100% of the possible total score); B – good practices in this area (from 50% to 75% of the possible total score) and C – poor practices needing immediate attention ( Results: The mean score for the hospital facility was 36% (27%–46%) in the C category. General ward facilities mean score was 83% (between 50% and 100%) in the A category. Biomedical waste management scored between 10% and 47% both in the C category. Adherence to policies regarding waste management scored 25%–50% in the C category. All the sites had dedicated labour rooms, and for all the modules, the mean score was Conclusions: Our study reveals that basic core components of IPC practices were not being fully implemented for safe delivery of babies. Antibiotics were being used inappropriately for normal delivery. A robust IPC programme and antimicrobial stewardship programme should be implemented in labour and delivery rooms.

Has the Public Health System Provided Adequate Financial Risk Protection for Child Birth Conditions - Evidences From an Eastern Indian State.

Over the years, national and sub-national governments have introduced several initiatives to improve access to maternal and child health services in India. However, financial barriers have posed major constraints. Based upon the data of National Family Health Survey (NFHS) round 4 for Odisha state, our paper examines the out-of-pocket expenditure (OOPE) borne by households for accessing maternal and child healthcare services in a low resource setting of India. We have interpreted results of NFHS-4 by drawing inferences from literature for understanding the rising OOPE in the public health system. Findings suggests that OOPE is considerably high for maternal and child health conditions in Odisha and ranks fifth, despite the coverage of 72% women under Janani Suraksha Yojana (JSY), a condition cash transfer scheme with majority utilizing the public health system. The high OOPE on child delivery raises numerous pertinent questions about the effectiveness of the public health delivery system, and thus requires financial protection in the interest of the population that accesses public health systems in the state.

Maternal health care access among migrant women labourers in the selected brick kilns of district Faridabad, Haryana: mixed method study on equity and access

BackgroundSocio-economic inequity leads to health inequity. Inequity is closely intertwined with internal migration. This study was planned with the objective of documenting the maternal health care utilization among women labourers working in brick kilns situated in an area of Haryana, north India.MethodsA community based mixed method study was done in select brick kilns of Faridabad district in north India. A mixed method study was done to assess maternal health care utilization in a sample of 500 women in the reproductive age group. Focus group discussions were also carried out. Descriptive analysis was done. Qualitative data was analysed using the thematic framework approach.ResultsThe mean age of the women was 30 (SD 0.3) years. Mean number of pregnancies per woman was 3.1 (SD 1.7). Only 22.9% ever had institutional delivery. About one third of women had ever received cash benefit under Janani SurakshaYojana (JSY) or had ever used free ambulance services. Seven major themes emerged from the qualitative analysis. Important themes include-Gaps in knowledge regarding local health system; Sub-standard private health care delivered at brick kilns prevent migrants from accessing the basic public health services; Misconceptions and mistrust about public health system influenced maternal health care utilization; Barriers to avail universal health coverage: location of brick kilns, time, apathy of public health system, partial health insurance cover.ConclusionsA typical migrant woman labourer in the brick kiln was an illiterate, had migrated from poor states, belonged to a socially disadvantaged community and worked long hours, and had been doing so for many years. This study has identified migrant women working in brick kilns as a vulnerable population subgroup in terms of maternal health utilization. To achieve universal health care it is important to understand the needs of all population subgroups and make concerted efforts at the health system level.

Determinants of antenatal care utilization in India: a spatial evaluation of evidence for public health reforms.

The objective is to examine the spatial variations and to identify the determinants of antenatal care (ANC) utilization while controlling for the spatial dependence in the data. This is an ecological study on ANC utilization data from District Level Household Survey-4 (2012-2013) in India. A secondary data analysis was performed on the derived data. The unit of analysis in this ecological study was 275 districts from 20 states of India. The study comprises ever married women of reproductive age. Determinants of ANC utilization were obtained using ordinary least square (OLS), spatial lag, and spatial error models. Model adequacy check was performed using the Akaike information criterion, R-squared, log likelihood, and Schwarz criterion. The software used is GeoDa and Quantum Geographic Information System. The presence of spatial autocorrelation (Moron's I=0.6210) enforces the usage of geographic properties while modeling. The geographic clustering of low-rate districts was observed in states in Northeast India. In the present study, the model adequacy check reveals that the spatial error model performs better than the spatial lag and OLS models. The spatial pattern of the percentage of pregnant women with full ANC was observed to be associated with literacy (P=0.04), birth order (P<0.001), Janani Suraksha Yojana beneficiaries (P=0.048), and availability of health infrastructure, staff, and services (P=0.023). The present study findings provide valuable insights into factors affecting ANC utilization. In addition to available ANC services, customized safe motherhood interventions and region-specific awareness programs would enhance the utilization, ensuring better maternal and child health.

The Impact of India’s Janani Suraksha Yojana Conditional Cash Transfer Programme: A Replication Study

In 2005 the government of India established Janani Suraksha Yojana (JSY), a conditional cash transfer programme to increase deliveries in health facilities. We re-examine an influential study published in 2010 on the effect of JSY on reproductive health coverage indicators and perinatal and neonatal mortality. We find the original authors’ results to be replicable and robust to various changes in model specifications and analysis. Through the use of multilevel models, we find meaningful heterogeneity across states and districts in the effects of JSY on the probabilities of in-facility delivery and skilled birth attendance, and neonatal mortality rates.

High-quality health systems in the Sustainable Development Goals era: time for a revolution.

High-quality health systems in the Sustainable Development Goals era: time for a revolution.

How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India

Janani Suraksha Yojana (safe motherhood scheme, or JSY) provides cash incentives to marginal pregnant women in India conditional on having mainly institutional delivery. Using the fourth round of district level household survey (DLHS-4), we have estimated its effects on both intended and unintended outcomes. Our estimates of average treatment effect on the treated (ATT) from propensity score matching are remarkably higher than those found in previous prominent studies using the second and third rounds of the survey (DLHS-2 and DLHS-3). When we apply fuzzy regression discontinuity design exploiting the second birth order, our estimates of local average treatment effect (LATE) are much higher than that of ATT. For example, due to JSY, institutional delivery increases by around 16 percentage points according to ATT estimate but about 23 percentage points according to LATE estimate.

Determinants for Acceptability of a Conditional Cash Transfer Scheme (Janani Suraksha Yojana) for Encouraging Institutional Deliveries among Antenatal Mothers

The objective of this artile is to assess the determinants of acceptance of conditional cash transfer scheme (Janani Suraksha Yojana [JSY]) among antenatal women in Mangalore.The study is on matched case control study. The study has been carried out in the Government maternity hospital of Manipal University and on the antenatal women visiting government hospital for Ante natal care (ANC) and belonged to below poverty line. Total of 136 pregnant females, that is, 68 cases (availing conditional cash benefit) and 68 controls (not availing conditional cash benefit), were recruited in the study. A pretested semi-structured questionnaire was used as data collection tool. The association between the educational status of the participant and their acceptance of JSY and association between the educational status of the participant’s spouse and acceptance of JSY by their wives has been found to be statistically significant. The JSY has been successfully promoting institutional deliveries.

Exploring the Bottlenecks: An Assessment of the Implementation Process of Janani Suraksha Yojana in the State of West Bengal, India

International Journal of Medicine and Public Health,2018,8,1,29-33.DOI:10.5530/ijmedph.2018.1.6Published:March 2018Type:Original ArticleExploring the Bottlenecks: An Assessment of the Implementation Process of Janani Suraksha Yojana in the State of West Bengal, IndiaDipta K Mukhopadhyay, Sujishnu Mukhopadhyay, Sarmila Mallik, Susmita Nayak, Asit Kumar Biswas, and Akhil B. Biswas Dipta K Mukhopadhyay1, Sujishnu Mukhopadhyay*2, Sarmila Mallik3, Susmita Nayak4, Asit Kumar Biswas5, Akhil B. Biswas6 1Associate Professor, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, INDIA 2Associate Professor, Malda Medical College, Malda, West Bengal, INDIA. 3Professor, Murshidabad Medical College, Bahrampur, West Bengal, INDIA. 4Consultant (Management), IHFW, GN 29, Sector 5, Salt Lake City, Kolkata, West Bengal, INDIA. 5Chief Medical Officer of Health, Darjeeling, West Bengal, INDIA. 6Professor, Institute of Health and Family Welfare, GN 29, Sector 5, Salt Lake City, Kolkata, West Bengal, INDIA. Abstract:Introduction: Empirical research reported that Janani Suraksha Yojana (JSY) accomplished the proximate target of increasing institutional delivery. However, discontents existed on the process and other outcomes of the scheme. Methods: To assess the implementation process of JSY in West Bengal, a cross-sectional study was conducted in six districts with population of 29.5 million covering 80 health sub-centers, 12 Primary health centers, 12 community health centers and six district hospitals. Data regarding barriers for utilization were collected through structured interview of the women who delivered within last 12 months. In-depth interviews of health personnel at different levels of government health system and review of relevant records were conducted to assess their awareness as well as flow of fund, record keeping and community-based monitoring of the scheme. Results: Almost universal awareness regarding benefits and conditionality of JSY among beneficiaries and health personnel, flexibility from health institutions for making the process of disbursement more users’ friendly, regular record keeping in cash books are the strengths of this scheme. Delay in disbursement and multiple visits from beneficiaries for receipt of incentive, almost no system of assessing the requirement of fund, inequitable distribution of fund and diversion of fund from other head to meet the expenses of JSY, lack of community-level monitoring of the scheme might potentially affect the success of the scheme. Conclusion: Removal of procedural complexities for beneficiaries, smooth flow of fund based on actual need and community-level monitoring are a few challenges that are to be redressed urgently. Keywords:Assessment, Cash incentives, India, JSY, Pregnant women, ProcessView:PDF (230.56 KB)