Cash or Quality? Impact of Public Policies on Use of Maternal Care in India

In recent years, the role of the state in provision of public services is being reexamined around the world with many experiment in alternative service delivery structures. India is at the forefront of some of these innovative programs which include one of world’s largest conditional cash transfer programs – payment to women and community health workers for hospital delivery as well as health insurance program for the poor where government pays the premiums for use of government as well private health facilities. These investments should improve maternal health outcomes including use of prenatal care, hospital delivery and postnatal care.
However, these programs are set up in a context where public service delivery systems remain indifferent to patient welfare, private health systems are poorly monitored and gender norms and intra-household inequalities constrain women’s ability to seek health care. Thus, careful evaluation of these programs and their impact is necessary to understand their effectiveness and ability to reach the poorest.
Using unique nationally representative longitudinal survey of over 40,000 households conducted before and after , this paper examines the impact of India’s Janani Suraksha Yojana (JSY), a conditional cash transfer program for hospital delivery, for improving access to maternal care.